Provider Demographics
NPI:1528380607
Name:PARK, JUNG HWA SARAH (LAC)
Entity Type:Individual
Prefix:
First Name:JUNG HWA
Middle Name:SARAH
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 N TUSTIN AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3601
Mailing Address - Country:US
Mailing Address - Phone:714-564-0226
Mailing Address - Fax:888-510-0082
Practice Address - Street 1:801 N TUSTIN AVE STE 305
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3601
Practice Address - Country:US
Practice Address - Phone:714-564-0226
Practice Address - Fax:888-510-0082
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist