Provider Demographics
NPI:1942447701
Name:PETER H PARK MD INC
Entity Type:Organization
Organization Name:PETER H PARK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-739-9936
Mailing Address - Street 1:3456 W. OLYMPIC BLVD.
Mailing Address - Street 2:101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2124
Mailing Address - Country:US
Mailing Address - Phone:213-386-3450
Mailing Address - Fax:213-386-3457
Practice Address - Street 1:3456 W. OLYMPIC BLVD.
Practice Address - Street 2:101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2124
Practice Address - Country:US
Practice Address - Phone:213-386-3450
Practice Address - Fax:213-386-3457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty