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NPI Code Detail

MEDICARE: DR. SAMUEL PARK M.D.

MEDICARE: DR. SAMUEL PARK M.D.
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 PhysicianA111437CA

General Provider Information

NPI Number : 1750532610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL PARK M.D.
Provider Business Mailing Address
First Line : 444 W GLENOAKS BLVD
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2917
Country : US
Telephone Number : 818-552-3000
Fax Number :
Provider Business Practice Location Address
First Line : 444 W GLENOAKS BLVD
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2917
Country : US
Telephone Number : 818-552-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2008
Last Update Date : 12/03/2021

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Directions to “ DR. SAMUEL PARK M.D.” Practice Location

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