Active NPI
Soh Young Park, AP,DOM
- Acupuncturist
- Lutz, FL
National Provider Identifier
1104662873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 4565
- Practice address
- 17501 N Dale Mabry Hwy # D
Lutz, FL 33548-4521 - Phone
- (813) 573-2756
- NPI assigned
- Jul 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 4565 | FL | Primary |
Addresses
Primary practice location
17501 N Dale Mabry Hwy # D
Lutz, FL 33548-4521
Mailing address
4627 Burkett Cir
Tampa, FL 33634-6207
Phone (813) 573-2756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4565 | FL | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Meridian LLC | Acupuncturist | Current | Accepting new patients |
Locations
17501 N Dale Mabry Hwy
#D
Lutz, FL 33548
Phone (813) 573-2756
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719878400000",
"number": "1104662873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4627 BURKETT CIR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336346207",
"telephone_number": "813-573-2756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17501 N DALE MABRY HWY # D",
"city": "LUTZ",
"state": "FL",
"postal_code": "335484521",
"telephone_number": "813-573-2756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SOH YOUNG",
"credential": "AP,DOM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-02",
"last_updated": "2024-07-02",
"certification_date": "2024-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "FL",
"license": "4565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lutz, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.