Samuel Ryan Park, Inc

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

A75650 Issued in CA

Legal business name

SAMUEL RYAN PARK, INC

Practice address

22 Odyssey Ste 155
Irvine, CA 92618-3194

Phone

(949) 207-7650

Fax

(949) 625-6135

NPI assigned

Sep 10, 2014

Last updated

Sep 10, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Ryan Park, MD

Title

Ceo

Phone

(949) 207-7650

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410307200000",
    "number": "1184025025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 ODYSSEY STE 155",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183194",
            "telephone_number": "949-207-7650",
            "fax_number": "949-625-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 ODYSSEY STE 155",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183194",
            "telephone_number": "949-207-7650",
            "fax_number": "949-625-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL RYAN PARK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-10",
        "last_updated": "2014-09-10",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-207-7650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A75650",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "A75650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Grace Bartolome Samonte-Mora, DDS
• Reena Shah Sampat, PA-C
• Megen Trouard Sampson, ARNP
• Roshni Samtani, PSY.D, LMFT
• Samuel Park MD a Medical Corporation (Odyssey Pain Center)
• Revai Nicole Samuel
• Michael Joseph Samuelson
• Samy Younis MD
• Samy Younis MD, Inc.
• San Acupuncture Corp. (Pacific Holistic Health Center)

• Interventional Pain Medicine Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; 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.