MEDICARE: DR. MIN SEUK PARK M.D.

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	207V00000X	Obstetrics & Gynecology Physician	G78220	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G78220	OTHER	CA	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962495572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIN SEUK PARK M.D.

Provider Business Mailing Address
First Line	:	4735 GOULD AVE
Second Line	:
City	:	LA CANADA FLINTRIDGE
State	:	CA
Zip	:	91011-2629
Country	:	US
Telephone Number	:	323-377-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 W OLYMPIC BLVD
Second Line	:	SUITE 220
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2810
Country	:	US
Telephone Number	:	213-382-0031
Fax Number	:	213-480-0463

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/28/2015

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Directions to “ DR. MIN SEUK PARK M.D.” Practice Location

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