Provider Demographics
NPI:1548641160
Name:PARK, EUNKYUNG (LAC)
Entity type:Individual
Prefix:MS
First Name:EUNKYUNG
Middle Name:
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 1:6927 BROCKTON AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3807
Mailing Address - Country:US
Mailing Address - Phone:951-233-3355
Mailing Address - Fax:951-783-9036
Practice Address - Street 1:6927 BROCKTON AVE STE 2C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3807
Practice Address - Country:US
Practice Address - Phone:951-233-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16514171100000X
CAAC 16514171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist