Provider Demographics
NPI:1780612283
Name:PARK, ERIC EUNGSOON (LAC, PHD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:EUNGSOON
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:EUNG
Other - Middle Name:SOON
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:30110 CROWN VALLEY PKWY
Mailing Address - Street 2:#107
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2043
Mailing Address - Country:US
Mailing Address - Phone:949-249-2839
Mailing Address - Fax:
Practice Address - Street 1:30110 CROWN VALLEY PKWY
Practice Address - Street 2:#107
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2043
Practice Address - Country:US
Practice Address - Phone:949-249-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10097171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist