Provider Demographics
NPI:1447284716
Name:PARK, SAEONG BIN (CA)
Entity type:Individual
Prefix:
First Name:SAEONG BIN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ALAMO PINTADO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2266
Mailing Address - Country:US
Mailing Address - Phone:805-686-0805
Mailing Address - Fax:805-686-0805
Practice Address - Street 1:650 ALAMO PINTADO RD STE 104
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2266
Practice Address - Country:US
Practice Address - Phone:805-686-0805
Practice Address - Fax:805-686-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC 7811171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist