Provider Demographics
NPI:1346572377
Name:PARK, DONG WOO (LAC)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:WOO
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:555 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE111
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-1612
Mailing Address - Country:US
Mailing Address - Phone:310-756-0001
Mailing Address - Fax:310-756-0004
Practice Address - Street 1:555 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE111
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-1612
Practice Address - Country:US
Practice Address - Phone:310-756-0001
Practice Address - Fax:310-756-0004
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC8057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist