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NPI Code Detail

MEDICARE: PETER PARK MD INC

MEDICARE: PETER PARK MD INC
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
1207Q00000XFamily Medicine PhysicianA54976CA

General Provider Information

NPI Number : 1154465631
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETER PARK MD INC
Provider Business Mailing Address
First Line : PO BOX 27206
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-0206
Country : US
Telephone Number : 213-385-0675
Fax Number : 213-365-6429
Provider Business Practice Location Address
First Line : 2600 W PICO BLVD
Second Line : SUITE 105
City : LOS ANGELES
State : CA
Zip : 90006-3902
Country : US
Telephone Number : 213-388-2772
Fax Number : 213-388-2112
Authorized Official
Title or Position : OWNER/MEDICAL DIRECTOR
Name : PETER TAKAYUKI ARAI
Credential : M.D.
Telephone Number : 213-388-2772
Provider Enumeration Date : 02/16/2007
Last Update Date : 04/10/2017

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Directions to “PETER PARK MD INC ” Practice Location

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