Provider Demographics
NPI:1063154466
Name:PARK, JUYOUNG (LAC,)
Entity type:Individual
Prefix:MR
First Name:JUYOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4923
Mailing Address - Country:US
Mailing Address - Phone:504-261-0168
Mailing Address - Fax:
Practice Address - Street 1:817 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4923
Practice Address - Country:US
Practice Address - Phone:504-261-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist