Provider Demographics
NPI:1316124480
Name:PARK, INSUNG (LAC)
Entity type:Individual
Prefix:MR
First Name:INSUNG
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 1:239 MATHER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08560
Mailing Address - Country:US
Mailing Address - Phone:732-754-0392
Mailing Address - Fax:609-520-1099
Practice Address - Street 1:239 MATHER AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-240-7060
Practice Address - Fax:908-272-3094
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00036500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist