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General NPI Number Information
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NPI Number | 1306872726
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Entity Type | Organization
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Legal Business Name | CHARLES J PARK INC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 24723 CALLE LARGO
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City | CALABASAS
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State | CA
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Zip | 91302-3014
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Country | US
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Telephone | 818-577-5654
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Fax |
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Provider Business Mailing Address
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Address Line | 24723 CALLE LARGO
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City | CALABASAS
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State | CA
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Zip | 91302-3014
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Country | US
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Telephone | 818-577-5654
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | CHARLES J. PARK
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Credential | M.D.
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Telephone | 818-577-5654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A51947
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A51947
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License Number State | CA
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