Justine Park, MD, Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A88512 Issued in CA

Legal business name

JUSTINE PARK, MD, INC.

Practice address

435 Arden Ave Ste 435
Glendale, CA 91203-4044

Phone

(818) 246-4936

Fax

(818) 246-4937

NPI assigned

Feb 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Justine Park, MD

Title

Owner

Phone

(818) 246-4936

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1360627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1306185285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 ARDEN AVE STE 435",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912034044",
            "telephone_number": "818-246-4936",
            "fax_number": "818-246-4937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 ARDEN AVE STE 435",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912034044",
            "telephone_number": "818-246-4936",
            "fax_number": "818-246-4937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTINE PARK, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-12",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JUSTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-246-4936",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A88512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; 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.