Provider Demographics
NPI:1932331410
Name:PARK, SEUNG HYUK (DPT)
Entity Type:Individual
Prefix:MR
First Name:SEUNG HYUK
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3868
Mailing Address - Country:US
Mailing Address - Phone:909-365-3557
Mailing Address - Fax:909-658-8987
Practice Address - Street 1:8545 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3868
Practice Address - Country:US
Practice Address - Phone:909-365-3557
Practice Address - Fax:909-658-8987
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8004225X00000X
CA35680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist