Provider Demographics
NPI:1336311539
Name:KP MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KP MEDICAL CORPORATION
Other - Org Name:TRINITY OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-746-3636
Mailing Address - Street 1:1005 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-3020
Mailing Address - Country:US
Mailing Address - Phone:213-745-3636
Mailing Address - Fax:213-745-3626
Practice Address - Street 1:1005 E WASHINGTON BLVD
Practice Address - Street 2:SUITE A-1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-3020
Practice Address - Country:US
Practice Address - Phone:213-745-3636
Practice Address - Fax:213-745-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty