Provider Demographics
NPI:1902920150
Name:PARK, WON HO (LAC)
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:HO
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:WON
Other - Middle Name:HO
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:7935 216TH ST SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-773-9010
Mailing Address - Fax:425-776-8873
Practice Address - Street 1:7935 216TH ST SW
Practice Address - Street 2:SUITE E
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-773-9010
Practice Address - Fax:425-776-8873
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000071171100000X
WAMA00003764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist