Provider Demographics
NPI:1649202698
Name:PARK, STEVE SEEKOOK (MD)
Entity type:Individual
Prefix:DR
First Name:STEVE SEEKOOK
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 S VIRGIL AVE
Mailing Address - Street 2:#200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1446
Mailing Address - Country:US
Mailing Address - Phone:213-387-8000
Mailing Address - Fax:213-769-5004
Practice Address - Street 1:500 S VIRGIL AVE
Practice Address - Street 2:#200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1446
Practice Address - Country:US
Practice Address - Phone:213-387-8000
Practice Address - Fax:213-769-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G714481Medicaid
060061949OtherRAILROAD MEDICARE
CA00G714481Medicaid
G714481Medicare ID - Type Unspecified