Provider Demographics
NPI:1750574083
Name:PARK, BILLIE K (DO)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:K
Last Name:PARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4300 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:714-577-6680
Mailing Address - Fax:714-579-6864
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2026
Practice Address - Country:US
Practice Address - Phone:714-577-6680
Practice Address - Fax:714-579-6864
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2021-11-09
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Provider Licenses
StateLicense IDTaxonomies
CA20A 10656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10656OtherOSTEOPATHIC MEDICAL BOARD