Healthcare Provider Details

I. General information

NPI: 1811159411
Provider Name (Legal Business Name): SUSAN KYUNG PARK MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-4061
  • Fax: 310-222-6740
Mailing address:
  • Phone: 424-306-4061
  • Fax: 310-222-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA111901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: