Se Ryung Park | Tustin, CA • PECOS Search

Se Ryung Park

Acupuncturist

Other Service Providers

15541 Williams St Apt D4, Tustin, CA 92780-4191

PECOS Enrollment

Based on the most recent information from CMS, provider Se Ryung Park does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1275178055
Provider Type
Individual
Full Name
Park, Se Ryung
Gender
Male

Sole Proprietor
Yes
Enumeration Date
11/15/2019
Last Updated
11/15/2019

Contact Information

Practice Location

15541 Williams St Apt D4, Tustin, CA 92780-4191

Unlisted Fax

Mailing Location

15541 Williams St Apt D4, Tustin, CA 92780-4191

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 171100000X Primary	Description Acupuncturist Other Service Providers	License 11324 California