Provider Demographics
NPI:1972538221
Name:PARK, JOHN (LAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2339 1/2 HONOLULU AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020
Mailing Address - Country:US
Mailing Address - Phone:818-330-9335
Mailing Address - Fax:818-330-9331
Practice Address - Street 1:2339 1/2 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1821
Practice Address - Country:US
Practice Address - Phone:818-330-9335
Practice Address - Fax:818-330-9331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist