Provider Demographics
NPI:1952908634
Name:PARK, SEJIN (DACM)
Entity Type:Individual
Prefix:DR
First Name:SEJIN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WYCOMBE PL
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6423
Mailing Address - Country:US
Mailing Address - Phone:609-651-5970
Mailing Address - Fax:
Practice Address - Street 1:355 US HIGHWAY 22 E STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3581
Practice Address - Country:US
Practice Address - Phone:908-325-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006772-01171100000X
NJNJDCATEMP-025390171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist