MEDICARE: DR. ERIN Y PARK D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E4088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508977711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN Y PARK D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 5036
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-7036
Country	:	US
Telephone Number	:	626-330-4866
Fax Number	:	626-330-7989

Provider Business Practice Location Address
First Line	:	2707 E VALLEY BLVD STE 303
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3198
Country	:	US
Telephone Number	:	626-330-4866
Fax Number	:	626-330-7989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/15/2025

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