Provider Demographics
NPI:1831483601
Name:ACUPUNCTURE & WELLNESS LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE & WELLNESS LLC
Other - Org Name:DR. PARK ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LAC
Authorized Official - Phone:410-997-0390
Mailing Address - Street 1:5550 STERRETT PL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2611
Mailing Address - Country:US
Mailing Address - Phone:410-997-0390
Mailing Address - Fax:410-885-4744
Practice Address - Street 1:5550 STERRETT PL
Practice Address - Street 2:SUITE 303
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2611
Practice Address - Country:US
Practice Address - Phone:410-997-0390
Practice Address - Fax:410-885-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD551510600OtherMEDICAL ASSISTANCE
MDC7VJS 92173902OtherCAREFIRST
DCY300-0001OtherCAREFIRST