NPIMap

Individual provider Active NPI

Alice J Park, M.D.

  • Nephrology Physician
  • Long Beach, CA
National Provider Identifier
1649336298
Registry record updated Aug 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A90337 Issued in CA
Practice address
3780 Kilroy Airport Way Ste 115
Long Beach, CA 90806
Phone
(562) 595-7426
Fax
(562) 989-3054
NPI assigned
Dec 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A90337 CA Primary

Addresses

Primary practice location

3780 Kilroy Airport Way Ste 115
Long Beach, CA 90806

Mailing address

3780 Kilroy Airport Way
Suite 115
Long Beach, CA 90806-2457
Phone (562) 595-7426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081121000453 CA Practitioner - NephrologyPractitioner - Internal MedicinePractitioner - Neurology 7416017389 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Saint Louis University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coast Nephrology Medical Group Inc.Group PAC ID 8628034659, 7 clinicians

Practice addresses (Care Compare)

2699 Atlantic Ave
Long Beach, CA 90806-2710
Phone (562) 426-3333

3780 Kilroy Airport Way
Suite 115
Long Beach, CA 90806-2458
Phone (562) 595-7426

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A90337CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Affiliates Medical Group CurrentSince Dec 8, 2018 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Dec 8, 2018 Accepting new patients
Los Alamitos Medical Center, Inc. Past Accepting new patients
John Hsieh MD Inc Nephrology Past Accepting new patients
St. Mary Medical Center Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients

Locations

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

2699 Atlantic Ave
Long Beach, CA 90806
Phone (562) 426-2105

1050 Linden Ave
Long Beach, CA 90813
Phone (562) 491-9000

601 Torrance Blvd
#1182
Redondo Beach, CA 90277

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: apark214322@westdirect.optum.com
  • Direct secure messaging: alice.j.park@direct.davitaphysiciansolutions.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1649336298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3780 KILROY AIRPORT WAY",
            "address_2": "SUITE 115",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062457",
            "telephone_number": "562-595-7426",
            "fax_number": "562-989-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 KILROY AIRPORT WAY STE 115",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90806",
            "telephone_number": "562-595-7426",
            "fax_number": "562-989-3054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ALICE",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A90337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.