Provider Demographics
NPI:1871350207
Name:PARK, YEON KYUNG (MS, LAC)
Entity type:Individual
Prefix:MS
First Name:YEON KYUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LEONARD ST APT 1513
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3666
Mailing Address - Country:US
Mailing Address - Phone:718-344-9241
Mailing Address - Fax:
Practice Address - Street 1:54 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1901
Practice Address - Country:US
Practice Address - Phone:201-818-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004446171100000X
NJ25MZ00101300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist