Provider Demographics
NPI:1831623495
Name:PARK, BYEONG HO (ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:BYEONG HO
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43754 GENERATION AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5796
Mailing Address - Country:US
Mailing Address - Phone:661-317-1868
Mailing Address - Fax:
Practice Address - Street 1:43754 GENERATION AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5796
Practice Address - Country:US
Practice Address - Phone:661-317-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist