Provider Demographics
NPI:1699031633
Name:PARK, MYUNG N I (MA 60266949)
Entity Type:Individual
Prefix:MRS
First Name:MYUNG
Middle Name:N
Last Name:PARK
Suffix:I
Gender:F
Credentials:MA 60266949
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 CENTER ST
Mailing Address - Street 2:SUITE #D
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2314
Mailing Address - Country:US
Mailing Address - Phone:253-230-3735
Mailing Address - Fax:
Practice Address - Street 1:5006 CENTER ST
Practice Address - Street 2:SUITE #D
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2314
Practice Address - Country:US
Practice Address - Phone:253-230-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60266949225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA 60266949OtherMA 60266949