Provider Demographics
NPI:1699047407
Name:PARK, YONG HOON (LAC)
Entity type:Individual
Prefix:MR
First Name:YONG
Middle Name:HOON
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:2076 BRIDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784
Mailing Address - Country:US
Mailing Address - Phone:714-474-3731
Mailing Address - Fax:909-939-2413
Practice Address - Street 1:1911 COMMERCENTER EAST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-890-0401
Practice Address - Fax:909-939-2413
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist