Provider Demographics
NPI:1316299548
Name:PARK, JULIA UNOK (LAC, MSOM, DIPLOM)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:UNOK
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC, MSOM, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4755
Mailing Address - Country:US
Mailing Address - Phone:503-804-0133
Mailing Address - Fax:
Practice Address - Street 1:1637 LAUREL ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-4755
Practice Address - Country:US
Practice Address - Phone:503-804-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC158600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist