Provider Demographics
NPI:1053552265
Name:PARK, OK-KYONG (LAC)
Entity type:Individual
Prefix:
First Name:OK-KYONG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3545 WILSHIRE BLVD
Mailing Address - Street 2:#300
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2305
Mailing Address - Country:US
Mailing Address - Phone:213-739-3113
Mailing Address - Fax:213-739-3113
Practice Address - Street 1:3545 WILSHIRE BLVD
Practice Address - Street 2:#300 LA
Practice Address - City:CA
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-739-3113
Practice Address - Fax:213-739-3113
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11460171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist