MEDICARE: WILLIAM BYUNG HO 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
1	207L00000X	Anesthesiology Physician	A52866C	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A528661	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821002288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BYUNG HO PARK M.D.

Provider Business Mailing Address
First Line	:	9828 GARDEN GROVE BLVD STE 201
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1659
Country	:	US
Telephone Number	:	714-530-9633
Fax Number	:	714-530-4410

Provider Business Practice Location Address
First Line	:	9828 GARDEN GROVE BLVD STE 201
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1659
Country	:	US
Telephone Number	:	714-530-9633
Fax Number	:	714-530-4410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/13/2008

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