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General NPI Number Information
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NPI Number | 1245143882
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Entity Type | Organization
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Legal Business Name | SMG MEDICAL PRACTICE GROUP PC
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 11911 ARTESIA BLVD STE 101
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City | CERRITOS
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State | CA
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Zip | 90701-4070
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Country | US
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Telephone | 562-402-7622
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Fax |
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Provider Business Mailing Address
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Address Line | 520 S VIRGIL AVE STE 507
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City | LOS ANGELES
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State | CA
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Zip | 90020-1452
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Country | US
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Telephone | 213-480-7770
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Fax |
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Authorized Official
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Title or Position | OWNER/ AO
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Name | RICHARD PARK
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Credential | MD
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Telephone | 999-999-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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