Provider Demographics
NPI:1851634448
Name:PARK, JIHYUK (MS, LAC)
Entity Type:Individual
Prefix:DR
First Name:JIHYUK
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CENTRAL RD
Mailing Address - Street 2:APT 701
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7333
Mailing Address - Country:US
Mailing Address - Phone:646-549-9620
Mailing Address - Fax:
Practice Address - Street 1:39 E 78TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0213
Practice Address - Country:US
Practice Address - Phone:646-549-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00095200171100000X
NY005203-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist