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General NPI Number Information
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NPI Number | 1164639704
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Entity Type | Organization
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Legal Business Name | WILSON H PARK, M.D.,INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 3663 W 6TH ST SUITE 100
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City | LOS ANGELES
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State | CA
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Zip | 90020-3049
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Country | US
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Telephone | 213-383-4000
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Fax | 213-427-5588
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Provider Business Mailing Address
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Address Line | 3663 W 6TH ST SUITE 100
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City | LOS ANGELES
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State | CA
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Zip | 90020-3049
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Country | US
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Telephone | 213-383-4000
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Fax | 213-427-5588
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILSON HO PARK
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Credential | M.D.
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Telephone | 213-383-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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