MEDICARE: SMG MEDICAL PRACTICE GROUP PC

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1710660659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMG MEDICAL PRACTICE GROUP PC

Provider Business Mailing Address
First Line	:	300 PARK AVE RM 2210
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-7402
Country	:	US
Telephone Number	:	646-453-5945
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 507
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1452
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD PARK
Credential	:	MD
Telephone Number	:	646-453-5945

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	02/20/2026

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