Healthcare Provider Details

I. General information

NPI: 1083061154
Provider Name (Legal Business Name): WILLIAM PARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6701
US

IV. Provider business mailing address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6701
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number21206
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA186058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: