Provider Demographics
NPI:1104002096
Name:ESTHER PARK, D.O., LLC
Entity Type:Organization
Organization Name:ESTHER PARK, D.O., LLC
Other - Org Name:PARK PSYCHIATRY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-258-3741
Mailing Address - Street 1:1101 DOVE ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2844
Mailing Address - Country:US
Mailing Address - Phone:949-258-3741
Mailing Address - Fax:949-258-3742
Practice Address - Street 1:1101 DOVE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2844
Practice Address - Country:US
Practice Address - Phone:949-258-3741
Practice Address - Fax:949-258-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A77342084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty