Provider Demographics
NPI:1225613326
Name:PARK, HWAN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:HWAN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 AVILA WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1155
Mailing Address - Country:US
Mailing Address - Phone:714-745-7635
Mailing Address - Fax:
Practice Address - Street 1:4980 AVILA WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1155
Practice Address - Country:US
Practice Address - Phone:714-745-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist