Individual
MR. TAESUN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
5441 BUFORD HWY NE # SUIT202, DORAVILLE, GA 30340-1124
(404) 488-9648
Mailing address
5441 BUFORD HWY, STE 202, DARAVILLE, GA 30340-1168
(770) 451-7848
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
125
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125
ACUPUNCTURE LICENSE NUMBE
GA
Enumeration date
04/27/2007
Last updated
02/12/2019
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