Provider Demographics
NPI:1467892570
Name:PARK, MIN H (LAC, DOM)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:MIN
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DOM
Mailing Address - Street 1:33100 PACIFIC HWY S STE 1
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6445
Mailing Address - Country:US
Mailing Address - Phone:253-815-9191
Mailing Address - Fax:253-815-8772
Practice Address - Street 1:33100 PACIFIC HWY S STE 1
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6445
Practice Address - Country:US
Practice Address - Phone:253-815-9191
Practice Address - Fax:253-815-8772
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist