Kerry Park, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G77252 Issued in CA

Practice address

1005 E Washington Blvd
Suite a-1
Los Angeles, CA 90021-3020

Phone

(323) 233-3100

Fax

(323) 233-4100

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• KP Medical Corporation

  • Specialist
  • Los Angeles, CA
  • NPI 1336311539
  NPD (past) Authorized official
• Cha Hollywood Medical Center, LP

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1922033547
  NPD (past)
• White Memorial Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1215927470
  NPD (past)

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554422400000",
    "number": "1962497149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 E WASHINGTON BLVD",
            "address_2": "SUITE A-1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900213020",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KERRY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2019-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G77252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "522355131",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G772520",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "G39493",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy Won Park, N.P.
• Keeyong Park, MD
• Kelly Park, MD
• Kendrick Park
• Kenneth Park, MD
• Kevin Park, DDS
• Kihyun Park
• Kristian Park, PHARMD
• Kristine Rachael Park, OD
• Kwang Soo Park, M.D.

• 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 Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.