Provider Demographics
NPI:1841381688
Name:PARKS, DAVID JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:PARKS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-289-3666
Mailing Address - Fax:310-289-8908
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-289-3666
Practice Address - Fax:310-289-8908
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG78517207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G785170Medicaid
CA1841381688OtherNPI
CA00G785170Medicaid