Sandra Sungju Park

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

25MZ00092100 Issued in NJ

Practice address

103 Waterside Dr
Little Ferry, NJ 07643-2208

Phone

(201) 741-7578

NPI assigned

Sep 18, 2012

Last updated

Dec 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Yittha Acupuncture LLC

  • Acupuncturist
  • Waldwick, NJ
  • NPI 1285388975
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1285984120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 WATERSIDE DR",
            "city": "LITTLE FERRY",
            "state": "NJ",
            "postal_code": "076432208",
            "telephone_number": "201-741-7578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 WATERSIDE DR",
            "city": "LITTLE FERRY",
            "state": "NJ",
            "postal_code": "076432208",
            "telephone_number": "201-741-7578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SANDRA",
        "middle_name": "SUNGJU",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NJ",
            "license": "25MZ00092100",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NJ",
            "license": "18KT00277700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Lauren O'Sullivan, BCBA
• One Adult Daycare Center Corp
• Maria Victoria Oribello, PT
• Karen Orland, RN, APN, FNP-C
• Leila Ostad-Hashemi, LCSW
• Taehee Park, PHARM. D.
• Partnerships for People, Inc.
• Partnerships for People, Inc.
• Partnerships for People, Inc.
• Partnerships for People, Inc.

• Acupuncturist in Little Ferry, NJ
• Providers in Little Ferry, NJ by specialty
• Acupuncturist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.