Wilson H Park, M.D.,Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WILSON H PARK, M.D.,INC.

Practice address

3663 W 6TH St
Suite 100
Los Angeles, CA 90020-3049

Phone

(213) 383-4000

Fax

(213) 427-5588

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Wilson Ho Park, M.D.NPI 1194855627

Title

President

Phone

(213) 383-4000

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• WILSON H PARK, M.D. Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19655/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Wilson Ho Park, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1194855627
  Medicare reassignment Authorized official
• Hongnan Jhang, NP

  • Nurse Practitioner
  • Los Angeles, CA
  • NPI 1528728078
  Medicare reassignment

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253145600000",
    "number": "1164639704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3663 W 6TH ST",
            "address_2": "SUITE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900203049",
            "telephone_number": "213-383-4000",
            "fax_number": "213-427-5588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3663 W 6TH ST",
            "address_2": "SUITE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900203049",
            "telephone_number": "213-383-4000",
            "fax_number": "213-427-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON H PARK, M.D.,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2009-09-17",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "WILSON",
        "authorized_official_middle_name": "HO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-383-4000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI  NUMBER",
            "identifier": "1194855627",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "G45867",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILSON H PARK, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Wilshire Wellness, Inc
• Wilshire West Dental GRP.
• Wilshire Westgate Dental, Inc.
• Wilshire Westgate Pharmacy
• Wilson C Park Chiropractic Corp
• Ashley Lynn Wilson-Dixon, MSW, ASW, PPSC
• Angelia Lynetta Wilson-Robinson, RN
• Abigail Leigh Wilson
• Agia Wilson
• Alanna Wilson

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2009; 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.