Healthcare Provider Details

I. General information

NPI: 1245143882
Provider Name (Legal Business Name): SMG MEDICAL PRACTICE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 ARTESIA BLVD STE 101
CERRITOS CA
90701-4070
US

IV. Provider business mailing address

520 S VIRGIL AVE STE 507
LOS ANGELES CA
90020-1452
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-7622
  • Fax:
Mailing address:
  • Phone: 213-480-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD PARK
Title or Position: OWNER/ AO
Credential: MD
Phone: 999-999-9999