Provider Demographics
NPI:1740538248
Name:PARK, ANNA ARONG (LAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ARONG
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 1:725 166TH ST
Mailing Address - Street 2:APT# 5C
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2061
Mailing Address - Country:US
Mailing Address - Phone:718-746-1545
Mailing Address - Fax:
Practice Address - Street 1:725 166TH ST
Practice Address - Street 2:APT# 5C
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2061
Practice Address - Country:US
Practice Address - Phone:718-746-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4809171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist