Provider Demographics
NPI:1013740299
Name:GOLDEN MERIDIAN LLC
Entity type:Organization
Organization Name:GOLDEN MERIDIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOH YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:813-573-2756
Mailing Address - Street 1:4627 BURKETT CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6207
Mailing Address - Country:US
Mailing Address - Phone:813-573-2756
Mailing Address - Fax:
Practice Address - Street 1:17501 N DALE MABRY HWY # D
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4521
Practice Address - Country:US
Practice Address - Phone:813-573-2756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty