Active NPI
Samuel A Park, M.D
- Specialist
- Beverly Hills, CA
National Provider Identifier
1902014566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G67123
- Practice address
- 9301 Wilshire Blvd
Suite 601
Beverly Hills, CA 90210-5424 - Phone
- (310) 777-0490
- Fax
- (310) 246-9422
- NPI assigned
- May 18, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | G67123 | CA | Primary |
Addresses
Primary practice location
9301 Wilshire Blvd
Suite 601
Beverly Hills, CA 90210-5424
Mailing address
9301 Wilshire Blvd
Suite 601
Beverly Hills, CALIFORNIA 90210
UM
Phone (310) 777-0490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 9, 2014 through Apr 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G67123 | CA | MD | Specialist |
| 67123 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902014566",
"addresses": [
{
"country_code": "UM",
"country_name": "United States Minor Outlying Islands",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "9301 WILSHIRE BLVD",
"address_2": "SUITE 601",
"city": "BEVERLY HILLS",
"state": "CALIFORNIA",
"postal_code": "90210",
"telephone_number": "310-777-0490",
"fax_number": "310-246-9422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9301 WILSHIRE BLVD",
"address_2": "SUITE 601",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902105424",
"telephone_number": "310-777-0490",
"fax_number": "310-246-9422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SAMUEL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G67123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beverly Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.