Provider Demographics
NPI:1164723946
Name:CHULHOON PARK, ACUPUNCTURE,INC.
Entity Type:Organization
Organization Name:CHULHOON PARK, ACUPUNCTURE,INC.
Other - Org Name:P & K ALTERNATIVE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHULHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:323-810-6259
Mailing Address - Street 1:1420 STARBUCK ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5670
Mailing Address - Country:US
Mailing Address - Phone:323-810-6259
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 465W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6111
Practice Address - Country:US
Practice Address - Phone:323-810-6259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13066261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center