NPIMap

Organization Active NPI

Justine Park, MD, Inc.

  • Dermatology Physician
  • Glendale, CA
National Provider Identifier
1306185285
Registry record updated Feb 12, 2013
On this page

Key facts

NPPES NPI Registry
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
Last updated
Feb 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2013

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

Authorized official

Name
Dr. Justine Park, MDNPI 1164570180
Title
Owner
Phone
(818) 246-4936

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X A88512 CA Primary

Addresses

Primary practice location

435 Arden Ave Ste 435
Glendale, CA 91203-4044

Mailing address

435 Arden Ave Ste 435
Glendale, CA 91203-4044
Phone (818) 246-4936

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": []
}

Other providers in Glendale, CA

Sources for this page

  • 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.