Stephen Park, M.D.
Individual provider Active NPI Pulmonary Disease Physician · Daly City, CA
NPI 1124050505 · NPPES record last updated Mar 24, 2015
Key facts
- NPI
- 1124050505
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- G55543 (CA)
- Practice address
- 1900 Sullivan Ave
Daly City, CA 94015-2200 - Phone
- (650) 991-0600
- Fax
- (650) 991-0306
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040618000879 | CA | Practitioner - Internal Medicine |
9830097179 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G55543 | CA | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of San Mateo | Current |
Accepting new patients | |
| County of San Mateo | Current |
Accepting new patients | |
| Daly City Hospitalist Group, Inc. | Past |
Accepting new patients | |
| Stephen Park MD | Pulmonary Disease | Past | Accepting new patients |
| Cogent Healthcare of Daly City, P.C. | Past | Accepting new patients |
Locations
222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | G55543 | CA | Yes |
Addresses
Primary practice location
1900 Sullivan Ave
Daly City, CA 94015-2200
Mailing address
418 Virginia Ave
San Mateo, CA 94402-2236
Phone (650) 455-4937
Other providers in Daly City, CA
- Holly Jo Pao
- Theodor Stephen Parada
- Josephine Paras
- Shannon Paras
- Jessie Picazo Pardilla
- Jensonmar Enrico Parreno
- Alisha Parrish
- Daniel David Parry
- Lobsang Tsering Partsang
- Ma Katrina Isabelle Franco Pascua
All providers in Daly City, CA · Pulmonary Disease Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.