Individual provider Active NPI

Erin Y Park, D.P.M.

  • Podiatrist
  • West Covina, CA
National Provider Identifier
1508977711
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E4088 Issued in CA
Practice address
2707 E Valley Blvd Ste 303
West Covina, CA 91792-3198
Phone
(626) 330-4866
Fax
(626) 330-7989
NPI assigned
Aug 31, 2006
Last updated
Jan 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E4088 CA Primary

Addresses

Primary practice location

2707 E Valley Blvd Ste 303
West Covina, CA 91792-3198

Mailing address

PO Box 5036
Diamond Bar, CA 91765-7036
Phone (626) 330-4866

Other identifiers 1

IdentifierTypeStateIssuer
000E40882MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050427000696 CA Practitioner - Podiatry 6103865399 Practice locations: West Covina, CA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2707 E Valley Blvd
Suite 303
West Covina, CA 91792-3198
Phone (626) 330-4866

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue110
Removal or shaving of skin growth49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4088CAMDAudiologist

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: erin.park.p1@direct.caremorewest.nextgenshare.com

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1508977711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5036",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917657036",
            "telephone_number": "626-330-4866",
            "fax_number": "626-330-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD STE 303",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923198",
            "telephone_number": "626-330-4866",
            "fax_number": "626-330-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ERIN",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E40882",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.