Active NPI
Siwan Park
- Acupuncturist
- Fullerton, CA
National Provider Identifier
1720793706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC19659
- Practice address
- 1649 W Orangethorpe Ave
Fullerton, CA 92833-4535 - Phone
- (714) 519-3883
- Fax
- (978) 334-5369
- NPI assigned
- Jan 13, 2023
- Sex
- Male
- 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 | AC19659 | CA | Primary |
Addresses
Primary practice location
1649 W Orangethorpe Ave
Fullerton, CA 92833-4535
Mailing address
1649 W Orangethorpe Ave
Fullerton, CA 92833-4535
Phone (714) 519-3883
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 |
|---|---|---|---|
| AC19659 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673568000000",
"number": "1720793706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1649 W ORANGETHORPE AVE",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928334535",
"telephone_number": "714-519-3883",
"fax_number": "978-334-5369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1649 W ORANGETHORPE AVE",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928334535",
"telephone_number": "714-519-3883",
"fax_number": "978-334-5369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SIWAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-13",
"last_updated": "2023-01-13",
"certification_date": "2023-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC19659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.