Provider Demographics
NPI:1184836785
Name:BARK, EUNJIN (LAC)
Entity Type:Individual
Prefix:DR
First Name:EUNJIN
Middle Name:
Last Name:BARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3526
Mailing Address - Country:US
Mailing Address - Phone:909-428-5816
Mailing Address - Fax:909-350-1427
Practice Address - Street 1:8237 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3526
Practice Address - Country:US
Practice Address - Phone:909-428-5816
Practice Address - Fax:909-350-1427
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11174171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist