Bruce Park, M.D. a Professional Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BRUCE PARK, M.D. A PROFESSIONAL CORPORATION

Practice address

1966 E Chapman Ave
Suite G
Fullerton, CA 92831-4142

Phone

(714) 525-0545

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bruce S Park, M.D.NPI 1841378825

Title

Ceo

Phone

(714) 525-0545

Specialties & licenses 1

Addresses

Other names 1

• bruce park md Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00037

Practitioners 5

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

• Bruce S Park, MD

  • Dermatology Physician
  • Fullerton, CA
  • NPI 1841378825
  Medicare reassignment NPD Authorized official
• Benny J Guzman, M.D.

  • Family Medicine Physician
  • Chino Hills, CA
  • NPI 1710988035
  NPD (past)
• Kathryn Elizabeth Kizzar, FNP-C

  • Family Nurse Practitioner
  • Apple Valley, CA
  • NPI 1912463589
  NPD (past)
• Galene Y Mead, PA

  • Physician Assistant
  • Chino Hills, CA
  • NPI 1326254020
  NPD (past)
• Dinh Nha Truong

  • Family Nurse Practitioner
  • Chino Hills, CA
  • NPI 1831861129
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1851478358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1966 E CHAPMAN AVE",
            "address_2": "SUITE G",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928314142",
            "telephone_number": "714-562-0542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1966 E CHAPMAN AVE",
            "address_2": "SUITE G",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928314142",
            "telephone_number": "714-525-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE PARK, M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-525-0545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "bruce park md",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Gray Clark Brown, L.C.S.W.
• Jeanie Brown, RAS
• Timothy Brown
• Yessica Brown
• Bruce P. Decarlo, MD, Inc.
• April Ann Brunetti, D.C.
• Bryan H Chung DMD Ms Inc
• Latanya Marie Bryant
• Christina Buchanan
• Dennis J Buchanan, MD

• Dermatology Physician in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.