Healthcare Provider Details

I. General information

NPI: 1376076620
Provider Name (Legal Business Name): BACK TO WORK ORTHOPEDIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 ALONDRA BLVD STE 100
PARAMOUNT CA
90723-4000
US

IV. Provider business mailing address

7300 ALONDRA BLVD STE 101
PARAMOUNT CA
90723-4000
US

V. Phone/Fax

Practice location:
  • Phone: 562-616-1166
  • Fax: 562-616-1141
Mailing address:
  • Phone: 562-531-8300
  • Fax: 562-531-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PARK
Title or Position: MD
Credential: MD
Phone: 562-616-1166