Provider Demographics
NPI:1679930572
Name:PARK, SUKHWA (LAC, PHD)
Entity Type:Individual
Prefix:
First Name:SUKHWA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2634
Mailing Address - Country:US
Mailing Address - Phone:213-925-5862
Mailing Address - Fax:323-426-9332
Practice Address - Street 1:4870 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:323-251-1750
Practice Address - Fax:323-426-9332
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14532171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist