Provider Demographics
NPI:1194855627
Name:PARK, WILSON HO (MD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:HO
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3663 W 6TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3049
Mailing Address - Country:US
Mailing Address - Phone:213-383-4000
Mailing Address - Fax:213-427-5588
Practice Address - Street 1:3663 W 6TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3049
Practice Address - Country:US
Practice Address - Phone:213-383-4000
Practice Address - Fax:213-427-5588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine