Provider Demographics
NPI:1063218899
Name:PARK, HYUNJIN (LAC)
Entity type:Individual
Prefix:
First Name:HYUNJIN
Middle Name:
Last Name:PARK
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 WILSHIRE BLVD APT 1516
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1018
Mailing Address - Country:US
Mailing Address - Phone:213-663-6677
Mailing Address - Fax:
Practice Address - Street 1:3400 W OLYMPIC BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2351
Practice Address - Country:US
Practice Address - Phone:213-365-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist