Patrick T. Park M D Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G76980 Issued in CA

Legal business name

PATRICK T. PARK M D INC

Practice address

266 S Harvard Blvd Ste 320
Los Angeles, CA 90004-4373

Phone

(213) 739-1025

Fax

(213) 739-9936

NPI assigned

Feb 27, 2009

Organization subpart

No

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

Authorized official

Name

Helen H Park

Title

Office Manager

Phone

(213) 739-1025

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick T Park, M.D.

  • Specialist
  • Los Angeles, CA
  • NPI 1215975594
  Medicare reassignment NPD

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1083854293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 S HARVARD BLVD STE 320",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044373",
            "telephone_number": "213-739-1025",
            "fax_number": "213-739-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 S HARVARD BLVD STE 320",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044373",
            "telephone_number": "213-739-1025",
            "fax_number": "213-739-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK T. PARK M D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "HELEN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "213-739-1025"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G76980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G769800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Augustine Patricio, ACNPC-AG
• Maria Cristina Patricio
• Patrick L Mullens M D Inc
• Patrick L Mullens M D Inc
• Patrick T. Bezdek M.D., Inc.
• Patrick Tully Licensed Marriage and Family Therapist Inc
• Angelina Patrick
• Candice Renee Patrick
• Carolyn Jeanette Patrick
• Kyra N/a Patrick

• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.