Provider Demographics
NPI:1952535270
Name:PARK, SANG BOG (L,AC)
Entity type:Individual
Prefix:
First Name:SANG BOG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:L,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PENINSULA CTR STE D
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3563
Mailing Address - Country:US
Mailing Address - Phone:310-541-7999
Mailing Address - Fax:310-544-1969
Practice Address - Street 1:50 PENINSULA CTR STE D
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3563
Practice Address - Country:US
Practice Address - Phone:310-541-7999
Practice Address - Fax:310-544-1969
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist