Provider Demographics
NPI:1699895862
Name:PARK, SUNGGUK (OMD LAC)
Entity type:Individual
Prefix:
First Name:SUNGGUK
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:OMD LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15435 S. WESTERN AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:310-324-2791
Mailing Address - Fax:310-324-2794
Practice Address - Street 1:15435 S. WESTERN AVE
Practice Address - Street 2:STE 203
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249
Practice Address - Country:US
Practice Address - Phone:310-324-2791
Practice Address - Fax:310-324-2794
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC9218171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist