Provider Demographics
NPI:1477712081
Name:PARK, GUNHWA (L AC)
Entity type:Individual
Prefix:MISS
First Name:GUNHWA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12792 VALLEY VIEW ST
Mailing Address - Street 2:D E
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2526
Mailing Address - Country:US
Mailing Address - Phone:714-392-5363
Mailing Address - Fax:
Practice Address - Street 1:12792 VALLEY VIEW ST
Practice Address - Street 2:D E
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2526
Practice Address - Country:US
Practice Address - Phone:714-392-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12502171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12502OtherACUPUNCTURE BAORD