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General NPI Number Information
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NPI Number | 1013835057
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Entity Type | Individual
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Provider Name | MICHELLE PARK
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Gender | Female
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 8484 WILSHIRE BLVD STE 620
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3234
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Country | US
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Telephone | 424-428-0910
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Fax |
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Provider Business Mailing Address
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Address Line | 3063 BROOKHILL ST
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City | LA CRESCENTA
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State | CA
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Zip | 91214-1926
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Country | US
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Telephone | 213-820-1704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95040460
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License Number State | CA
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