Provider Demographics
NPI:1376749879
Name:PARK, MYUNGREA (AC)
Entity Type:Individual
Prefix:MISS
First Name:MYUNGREA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 W ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5649
Mailing Address - Country:US
Mailing Address - Phone:951-278-2163
Mailing Address - Fax:951-278-2163
Practice Address - Street 1:535 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3218
Practice Address - Country:US
Practice Address - Phone:951-737-1252
Practice Address - Fax:951-737-2820
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist