Provider Demographics
NPI:1982829636
Name:PARK, EUN J (LAC)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:J
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 F ST.
Mailing Address - Street 2:F-11
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1845
Mailing Address - Country:US
Mailing Address - Phone:661-434-3415
Mailing Address - Fax:888-498-7692
Practice Address - Street 1:2920 F ST STE F11
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1829
Practice Address - Country:US
Practice Address - Phone:661-434-3415
Practice Address - Fax:888-498-7692
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist