Provider Demographics
NPI:1982822086
Name:PARK, NAM WOON
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:WOON
Last Name:PARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S BEACH BLVD
Mailing Address - Street 2:#203
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6366
Mailing Address - Country:US
Mailing Address - Phone:562-902-1010
Mailing Address - Fax:562-902-8787
Practice Address - Street 1:1201 S BEACH BLVD
Practice Address - Street 2:#203
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6366
Practice Address - Country:US
Practice Address - Phone:562-902-1010
Practice Address - Fax:562-902-8787
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist