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General NPI Number Information
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NPI Number | 1902014566
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Entity Type | Individual
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Provider Name | SAMUEL A PARK M.D
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9301 WILSHIRE BLVD SUITE 601
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5424
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Country | US
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Telephone | 310-777-0490
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Fax | 310-246-9422
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Provider Business Mailing Address
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Address Line | 9301 WILSHIRE BLVD SUITE 601
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City | BEVERLY HILLS
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State | CALIFORNIA
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Zip | 90210
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Country | UM
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Telephone | 310-777-0490
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Fax | 310-246-9422
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G67123
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License Number State | CA
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