Jae Seog Park

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC5537 Issued in CA

Practice address

12640 Hesperia Rd Ste D
Victorville, CA 92395-7753

Phone

(760) 684-4143

Fax

(760) 684-8111

NPI assigned

Dec 12, 2006

Last updated

Mar 4, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Tobias Moeller-Bertram MD Corporation

  dba Lifekind Health

  • Pain Medicine (Anesthesiology) Physician
  • Rancho Mirage, CA
  • NPI 1922440684
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1386705614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12640 HESPERIA RD STE D",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957753",
            "telephone_number": "760-684-4143",
            "fax_number": "760-684-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12640 HESPERIA RD STE D",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957753",
            "telephone_number": "760-684-4143",
            "fax_number": "760-684-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAE",
        "middle_name": "SEOG",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC5537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanjukta Panigrahi
• Sonia Panjwani, M.D.
• Paramount Professionals Inc (Imperial Home Health)
• Tania Parhami, FNP-C
• Sujal Hemantkumar Parikh
• Joe Park, M.D.
• Sook Ja Park, FNP-BC, ANP-BC
• Kimberly Coraline Parker
• Regina Felicia Parker, CPT1
• Sandra Ann Parker, GUARDIAN

• Acupuncturist in Victorville, CA
• Providers in Victorville, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; 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.