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NPI Code Detail

MEDICARE: SANG KYU PARK

MEDICARE:   SANG KYU  PARK
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
1225200000XPhysical Therapy Assistant49936CA

General Provider Information

NPI Number : 1245869932
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANG KYU PARK
Provider Business Mailing Address
First Line : 421 S LA FAYETTE PARK PL APT 515
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-1651
Country : US
Telephone Number : 213-215-0650
Fax Number :
Provider Business Practice Location Address
First Line : 421 S LA FAYETTE PARK PL APT 515
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-1651
Country : US
Telephone Number : 213-215-0650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2020
Last Update Date : 04/03/2020

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Directions to “ SANG KYU PARK ” Practice Location

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