Provider Demographics
NPI:1982851168
Name:PARK, JENNIFER EUNHEE
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:EUNHEE
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:J. EUNHEE
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10171 BRILEY WAY
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4239
Mailing Address - Country:US
Mailing Address - Phone:714-921-3007
Mailing Address - Fax:
Practice Address - Street 1:721 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4116
Practice Address - Country:US
Practice Address - Phone:714-774-1001
Practice Address - Fax:714-774-1140
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6206171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist