Provider Demographics
NPI:1336681238
Name:PARK, JUNG
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 PRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-1215
Mailing Address - Country:US
Mailing Address - Phone:832-660-8409
Mailing Address - Fax:713-910-6078
Practice Address - Street 1:308 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-1215
Practice Address - Country:US
Practice Address - Phone:832-660-8409
Practice Address - Fax:713-910-6078
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist