Provider Demographics
NPI:1891946463
Name:PARK, CHRISTINA CHUNLAN (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CHUNLAN
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CHUNLAN
Other - Middle Name:
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 CONOVER RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3230
Mailing Address - Country:US
Mailing Address - Phone:212-748-9123
Mailing Address - Fax:
Practice Address - Street 1:525 MILLTOWN RD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3317
Practice Address - Country:US
Practice Address - Phone:732-545-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002884-1171100000X
NJ24MZ00054700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist