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NPI Code Detail

MEDICARE: PETER SANG-WOOK PARK DPM

MEDICARE: PETER SANG-WOOK PARK DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristE4031CA
2213E00000XPodiatristE4031CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CE813AOTHERCAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100E40310OTHERCAMEDI CAL
21104825033OTHERCANPI

General Provider Information

NPI Number : 1104825033
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER SANG-WOOK PARK DPM
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 8311 FLORENCE AVE
Second Line :
City : DOWNEY
State : CA
Zip : 90240-3928
Country : US
Telephone Number : 562-923-4911
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 01/05/2026

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Directions to “ PETER SANG-WOOK PARK DPM” Practice Location

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