Kevin S Park MD Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A67776 Issued in CA

Legal business name

KEVIN S PARK MD INC

Practice address

11411 Brookshire Ave
Suite 200
Downey, CA 90241-4985

Phone

(562) 869-4421

Fax

(562) 869-3600

NPI assigned

Jan 16, 2009

Organization subpart

No

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

Authorized official

Name

Kevin Songchol Park, M.D.NPI 1093823494

Title

President

Phone

(562) 869-4421

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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

• Kevin S. Park, M.D.

  • Orthopaedic Surgery Physician
  • Downey, CA
  • NPI 1093823494
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287100800000",
    "number": "1528205226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11411 BROOKSHIRE AVE",
            "address_2": "SUITE 200",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414985",
            "telephone_number": "562-869-4421",
            "fax_number": "562-869-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11411 BROOKSHIRE AVE",
            "address_2": "SUITE 200",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414985",
            "telephone_number": "562-869-4421",
            "fax_number": "562-869-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN S PARK MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-16",
        "last_updated": "2010-10-15",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "SONGCHOL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-869-4421",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A67776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Fuqua Kerbel, PT, DPT
• Lisa Kerestedjian, M.D.
• Ankit J Keshav, DDS
• Jayantilal Rama Keshav, D.D.S.
• Shivani J Keshav, DDS
• Steven J Keyser, C.O.
• Christine Kha, DO
• Arsineh Khachekian, D.O.
• Khalifa Mansour, MD, a Medical Corporation
• Alia Khalil, D.O.

• Specialist in Downey, CA
• Providers in Downey, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.