Provider Demographics
NPI:1730499039
Name:PARK, YOUL N/A (AC)
Entity Type:Individual
Prefix:
First Name:YOUL
Middle Name:N/A
Last Name:PARK
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 164TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5947
Mailing Address - Country:US
Mailing Address - Phone:425-745-2311
Mailing Address - Fax:206-400-7707
Practice Address - Street 1:125 164TH ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5947
Practice Address - Country:US
Practice Address - Phone:425-745-2311
Practice Address - Fax:206-400-7707
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60185525171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist