Provider Demographics
NPI:1528231941
Name:PARK, EUNJU (LAC)
Entity Type:Individual
Prefix:
First Name:EUNJU
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 LEE PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5108
Mailing Address - Country:US
Mailing Address - Phone:972-439-4765
Mailing Address - Fax:
Practice Address - Street 1:3303 LEE PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5108
Practice Address - Country:US
Practice Address - Phone:972-439-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist