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General NPI Number Information
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NPI Number | 1245351808
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Entity Type | Organization
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Legal Business Name | BEACON COMMUNITY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 2017 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-3705
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Country | US
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Telephone | 213-480-1000
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Fax | 213-401-0018
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Provider Business Mailing Address
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Address Line | 2017 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-3705
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Country | US
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Telephone | 213-480-1000
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Fax | 213-401-0018
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM JONATHAN PARK
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Credential | D.C.
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Telephone | 213-480-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A54010
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 20A8246
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC29535
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License Number State | CA
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