Provider Demographics
NPI:1326247016
Name:PARK, SEOK (PHD, LAC)
Entity Type:Individual
Prefix:
First Name:SEOK
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:PHD, 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 STERRETT PL STE 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2643
Mailing Address - Country:US
Mailing Address - Phone:410-997-0390
Mailing Address - Fax:410-885-4744
Practice Address - Street 1:5550 STERRETT PL STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2643
Practice Address - Country:US
Practice Address - Phone:410-997-0390
Practice Address - Fax:410-885-4744
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11889171100000X
MDU01592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC7VJS 92173902OtherCAREFIRST
DCY300-0001OtherCAREFIRST
MD443601600OtherMEDICAL ASSISTANCE