Provider Demographics
NPI:1235747957
Name:PARK, MOON HUN (LAC)
Entity Type:Individual
Prefix:
First Name:MOON
Middle Name:HUN
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20010 FISHER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2051
Mailing Address - Country:US
Mailing Address - Phone:301-979-3375
Mailing Address - Fax:
Practice Address - Street 1:11269 OLD FREDERICK RD
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1518
Practice Address - Country:US
Practice Address - Phone:240-416-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist