Individual provider Active NPI

Rack Joon Park, L.AC

  • Acupuncturist
  • Tustin, CA
National Provider Identifier
1659712487
Registry record updated Jul 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC12816 Issued in CA
Practice address
14151 Newport Ave
Suite 102
Tustin, CA 92780-5163
Phone
(714) 838-8931
NPI assigned
Jul 9, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC12816 CA Primary

Addresses

Primary practice location

14151 Newport Ave
Suite 102
Tustin, CA 92780-5163

Mailing address

616 Wycliffe
Irvine, CA 92602-1214
Phone (714) 866-6545

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

LicenseStateTypeSpecialty
AC12816CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Fushimi Balance Acupuncture Acupuncturist PastSince Jul 27, 2020 Accepting new patients
Keith Norman Kausler DC Inc-a Past Accepting new patients

Organizations & group practices 2

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": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1659712487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 WYCLIFFE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926021214",
            "telephone_number": "714-866-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14151 NEWPORT AVE",
            "address_2": "SUITE 102",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927805163",
            "telephone_number": "714-838-8931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "RACK JOON",
        "credential": "L.AC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC12816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.