Peter H Park MD Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G67513 Issued in CA

Legal business name

PETER H PARK MD INC

Practice address

3456 W. Olympic Blvd.
101
Los Angeles, CA 90019-2124

Phone

(213) 386-3450

Fax

(213) 386-3457

NPI assigned

Jan 15, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Peter H Park, M.D.NPI 1225076516

Title

President

Phone

(213) 739-9936

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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

• Peter H Park, M.D,

  • Specialist
  • Los Angeles, CA
  • NPI 1225076516
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1942447701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3456 W. OLYMPIC BLVD.",
            "address_2": "101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900192124",
            "telephone_number": "213-386-3450",
            "fax_number": "213-386-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3456 W. OLYMPIC BLVD.",
            "address_2": "101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900192124",
            "telephone_number": "213-386-3450",
            "fax_number": "213-386-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER H PARK MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-15",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-739-9936",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G67513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.