Provider Demographics
NPI:1053433235
Name:PARK, HEE BANG (ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:HEE
Middle Name:BANG
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 1:22640 GOLDEN SPRINGS DR
Mailing Address - Street 2:# B
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2200
Mailing Address - Country:US
Mailing Address - Phone:909-861-1730
Mailing Address - Fax:
Practice Address - Street 1:22640 GOLDEN SPRINGS DR
Practice Address - Street 2:# B
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2200
Practice Address - Country:US
Practice Address - Phone:909-861-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8467171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0084670Medicaid