Active NPI
Maggie Park
- Pediatrics Physician
- Stockton, CA
National Provider Identifier
1639290463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A79109
- Practice address
- 7210 Murray Dr
Stockton, CA 95210 - Phone
- (209) 373-2800
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A79109 | CA | Primary |
Addresses
Primary practice location
7210 Murray Dr
Stockton, CA 95210
Mailing address
7210 Murray Dr
Stockton, CA 95210-3339
Phone (209) 373-2800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79109 | CA | MD | Pharmacist |
| A79109 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331683200000",
"number": "1639290463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7210 MURRAY DR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952103339",
"telephone_number": "209-373-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7210 MURRAY DR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95210",
"telephone_number": "209-373-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MAGGIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2012-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A79109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.