Provider Demographics
NPI:1316081433
Name:PARK, HYEON JOO (DC)
Entity type:Individual
Prefix:
First Name:HYEON JOO
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WILSHIRE BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1307
Mailing Address - Country:US
Mailing Address - Phone:213-381-5500
Mailing Address - Fax:213-381-5598
Practice Address - Street 1:3200 WILSHIRE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1307
Practice Address - Country:US
Practice Address - Phone:213-381-5500
Practice Address - Fax:213-381-5598
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor