Provider Demographics
NPI:1215027008
Name:PARK, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18436 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4107
Mailing Address - Country:US
Mailing Address - Phone:855-504-4544
Mailing Address - Fax:
Practice Address - Street 1:DILOREZNO TRICARE HEALTH CLINIC
Practice Address - Street 2:FEDERAL BUILDING 2, RM 1345
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20370-0001
Practice Address - Country:US
Practice Address - Phone:703-614-2726
Practice Address - Fax:703-614-1593
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC549642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology