Provider Demographics
NPI:1427523422
Name:PARK, JOSHUA JUNSE (DSOM, LAC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JUNSE
Last Name:PARK
Suffix:
Gender:M
Credentials:DSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1075
Mailing Address - Country:US
Mailing Address - Phone:954-276-5603
Mailing Address - Fax:954-985-7073
Practice Address - Street 1:601 N FLAMINGO RD STE 400
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1011
Practice Address - Country:US
Practice Address - Phone:954-844-9080
Practice Address - Fax:954-844-9081
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty