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General NPI Number Information
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NPI Number | 1104705664
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Entity Type | Individual
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Provider Name | DANIEL WON PARK PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 3630 E IMPERIAL HWY
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City | LYNWOOD
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State | CA
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Zip | 90262
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Country | US
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Telephone | 310-900-8900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 01796
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City | LOS ANGELES
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State | CA
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Zip | 90001
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Country | US
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Telephone | 562-536-3184
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 308582
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License Number State | CA
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