Provider Demographics
NPI:1245325067
Name:PARK, HONG BUM (DC)
Entity type:Individual
Prefix:DR
First Name:HONG
Middle Name:BUM
Last Name:PARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3562
Mailing Address - Country:US
Mailing Address - Phone:213-388-9683
Mailing Address - Fax:133-889-6962
Practice Address - Street 1:4221 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3562
Practice Address - Country:US
Practice Address - Phone:213-388-9683
Practice Address - Fax:213-388-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV10528Medicare UPIN