Healthcare Provider Details

I. General information

NPI: 1861663338
Provider Name (Legal Business Name): WILLIAM PARK, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

PO BOX 1809
ORANGE CA
92856-0809
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-5000
  • Fax: 562-904-5140
Mailing address:
  • Phone: 714-560-1580
  • Fax: 714-560-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA52866
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM PARK
Title or Position: PRESIDENT
Credential: MD
Phone: 949-706-4433