Provider Demographics
NPI:1124880521
Name:PARK, JAMES EUN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EUN
Last Name:PARK
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 SEAVIEW AVE # 2130
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2484
Mailing Address - Country:US
Mailing Address - Phone:808-342-1056
Mailing Address - Fax:
Practice Address - Street 1:7192 KALANIANAOLE HWY STE E206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1849
Practice Address - Country:US
Practice Address - Phone:808-797-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT6448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist