Organization
FOUR LEAF WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUNG MI PARK L. AC (ACUPUNCTURIST)
(443) 857-4192
Entity
Organization
Contact information
Practice address
12651 VINCENTS WAY, CLARKSVILLE, MD 21029-1492
(443) 857-4192
Mailing address
12651 VINCENTS WAY, CLARKSVILLE, MD 21029-1492
(443) 857-4192
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U01546
THE MARYLAND STATE BOARD OF ACUPUNCTURE
MD
Enumeration date
06/06/2021
Last updated
06/06/2021
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