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General NPI Number Information
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NPI Number | 1851530687
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Entity Type | Organization
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Legal Business Name | WILLIAM PARK, M.D., INC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 9828 GARDEN GROVE BLVD 201
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1639
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Country | US
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Telephone | 714-530-9633
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Fax | 714-530-4410
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Provider Business Mailing Address
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Address Line | 9828 GARDEN GROVE BLVD 201
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1639
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Country | US
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Telephone | 714-530-9633
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Fax | 714-530-4410
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM PARK
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Credential | M.D.
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Telephone | 714-530-9633
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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 | A52866
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License Number State | CA
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