Provider Demographics
NPI:1396982096
Name:PARK, HEYN ELINA (LAC)
Entity type:Individual
Prefix:
First Name:HEYN
Middle Name:ELINA
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 1:11239 VENTURA BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3163
Mailing Address - Country:US
Mailing Address - Phone:213-718-1831
Mailing Address - Fax:
Practice Address - Street 1:11239 VENTURA BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3163
Practice Address - Country:US
Practice Address - Phone:213-718-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC 12507171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL.AC 12507OtherACUPUNCTURE