Provider Demographics
NPI:1871383299
Name:JAE HYUN PARK
Entity type:Organization
Organization Name:JAE HYUN PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-405-4009
Mailing Address - Street 1:4949 BUCKLEY WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4880
Mailing Address - Country:US
Mailing Address - Phone:661-405-4009
Mailing Address - Fax:
Practice Address - Street 1:4949 BUCKLEY WAY STE 104
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4880
Practice Address - Country:US
Practice Address - Phone:661-405-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty