Individual
JAE KWAN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5715 256TH ST, LITTLE NECK, NY 11362-2140
(917) 545-3143
Mailing address
5715 256TH ST, LITTLE NECK, NY 11362-2140
(917) 545-3143
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
005860
NY
Other
Enumeration date
11/15/2021
Last updated
11/15/2021
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