Provider Demographics
NPI:1164470829
Name:PARK, WILLIAM IL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:IL
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11 BUCKSKIN RD
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1121
Mailing Address - Country:US
Mailing Address - Phone:808-895-1018
Mailing Address - Fax:
Practice Address - Street 1:11 BUCKSKIN RD
Practice Address - Street 2:
Practice Address - City:BELL CANYON
Practice Address - State:CA
Practice Address - Zip Code:91307-1121
Practice Address - Country:US
Practice Address - Phone:808-895-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51513208600000X
HI13391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery