Provider Demographics
NPI:1306900691
Name:PARK, DONG-RAE (OMD, LIC ACUPUNC)
Entity type:Individual
Prefix:DR
First Name:DONG-RAE
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:OMD, LIC ACUPUNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 PRESTON RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2745
Mailing Address - Country:US
Mailing Address - Phone:214-691-3210
Mailing Address - Fax:214-739-6262
Practice Address - Street 1:11661 PRESTON RD
Practice Address - Street 2:SUITE 170
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2745
Practice Address - Country:US
Practice Address - Phone:214-691-3210
Practice Address - Fax:214-739-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00184171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist