Samuel Park MD a Medical Corporation

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

A75650 Issued in CA

Legal business name

SAMUEL PARK MD A MEDICAL CORPORATION

Doing business as

Odyssey Pain Center

Practice address

22 Odyssey Ste 155
Irvine, CA 92618-3194

Phone

(949) 207-7650

NPI assigned

Jul 27, 2012

Last updated

Dec 30, 2012By 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

President

Phone

(949) 207-7650

Specialties & licenses 1

Addresses

Other names 1

• Odyssey Pain Center Doing business as

Locations

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356825600000",
    "number": "1528314515",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL PARK MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-27",
        "last_updated": "2012-12-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-207-7650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A75650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odyssey Pain Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samonte Mora Najaran Dental (Sand Canyon Dental)
• Mary Grace Bartolome Samonte-Mora, DDS
• Reena Shah Sampat, PA-C
• Megen Trouard Sampson, ARNP
• Roshni Samtani, PSY.D, LMFT
• Samuel Ryan Park, Inc
• Revai Nicole Samuel
• Michael Joseph Samuelson
• Samy Younis MD
• Samy Younis MD, Inc.

• Pain Medicine (Anesthesiology) Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Pain Medicine (Anesthesiology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2012; 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.