Provider Demographics
NPI:1851901367
Name:PARK, HEE-JIN (LAC)
Entity Type:Individual
Prefix:
First Name:HEE-JIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:HEE-JIN
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:15324 MAIN ST E STE B
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2698
Mailing Address - Country:US
Mailing Address - Phone:206-928-9393
Mailing Address - Fax:206-928-9395
Practice Address - Street 1:15324 MAIN ST E STE B
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2698
Practice Address - Country:US
Practice Address - Phone:206-928-9393
Practice Address - Fax:206-928-9395
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist