Provider Demographics
NPI:1306008685
Name:PARK, IN H (ACUPUNCTURE)
Entity Type:Individual
Prefix:DR
First Name:IN
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACUPUNCTURE
Mailing Address - Street 1:421 N. BROOKHURST ST.#218
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2565
Mailing Address - Country:US
Mailing Address - Phone:714-726-9955
Mailing Address - Fax:844-272-2361
Practice Address - Street 1:421 N BROOKHURST ST STE 218
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5619
Practice Address - Country:US
Practice Address - Phone:714-726-9955
Practice Address - Fax:714-816-1622
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8213171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC8213OtherCALIFORNIA ACUPUNCTURE LICENSE NUMBER