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General NPI Number Information
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NPI Number | 1881895316
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Entity Type | Individual
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Provider Name | KENNETH PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 5215 TORRANCE BLVD STE 210
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City | TORRANCE
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State | CA
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Zip | 90503-4009
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Country | US
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Telephone | 310-316-6190
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Fax | 310-540-7362
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Provider Business Mailing Address
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Address Line | 5215 TORRANCE BLVD STE 210
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City | TORRANCE
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State | CA
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Zip | 90503-4009
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Country | US
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Telephone | 310-316-6190
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Fax | 310-540-7362
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | TRN6888
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | A108380
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License Number State | CA
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