Provider Demographics
NPI:1174061956
Name:PARK, SEUNG K (LAC, LMT)
Entity type:Individual
Prefix:
First Name:SEUNG
Middle Name:K
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 128TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1938
Mailing Address - Country:US
Mailing Address - Phone:205-285-7837
Mailing Address - Fax:
Practice Address - Street 1:20 E 35TH ST
Practice Address - Street 2:#1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3887
Practice Address - Country:US
Practice Address - Phone:205-285-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005909171100000X
NY015929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist