Healthcare Provider Details

I. General information

NPI: 1588723399
Provider Name (Legal Business Name): HO SEONG PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S VERMONT AVE 101
LOS ANGELES CA
90005-1584
US

IV. Provider business mailing address

808 S VERMONT AVE 101
LOS ANGELES CA
90005-1584
US

V. Phone/Fax

Practice location:
  • Phone: 213-382-5420
  • Fax: 213-382-7404
Mailing address:
  • Phone: 213-382-5420
  • Fax: 213-382-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA363110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: