Provider Demographics
NPI:1063104545
Name:PARK, SEUNG JUN STEVE (OTR/L)
Entity type:Individual
Prefix:MR
First Name:SEUNG JUN
Middle Name:STEVE
Last Name:PARK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 BARTON AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2759
Mailing Address - Country:US
Mailing Address - Phone:213-700-9100
Mailing Address - Fax:
Practice Address - Street 1:6040 BARTON AVE APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2759
Practice Address - Country:US
Practice Address - Phone:213-700-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist