Provider Demographics
NPI:1922210392
Name:PARK, SOONHO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:SOONHO
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2558
Mailing Address - Country:US
Mailing Address - Phone:213-384-7275
Mailing Address - Fax:213-384-7275
Practice Address - Street 1:3053 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2558
Practice Address - Country:US
Practice Address - Phone:213-384-7275
Practice Address - Fax:213-384-7275
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist