Provider Demographics
NPI:1235843475
Name:PARK, SEIYOUNG (LAC)
Entity Type:Individual
Prefix:MISS
First Name:SEIYOUNG
Middle Name:
Last Name:PARK
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 1:5550 WILSHIRE BLVD APT 321
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4859
Mailing Address - Country:US
Mailing Address - Phone:424-245-5623
Mailing Address - Fax:424-245-5623
Practice Address - Street 1:5550 WILSHIRE BLVD APT 321
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4859
Practice Address - Country:US
Practice Address - Phone:424-245-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist