MEDICARE: JAKOB 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
1	207R00000X	Internal Medicine Physician	A178342	CA
2	207RC0000X	Cardiovascular Disease Physician	A178342	CA

General Provider Information

NPI Number	:	1841795416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKOB PARK

Provider Business Mailing Address
First Line	:	127 S SAN VICENTE BLVD STE A3100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3311
Country	:	US
Telephone Number	:	310-248-6719
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 S SAN VICENTE BLVD STE A3100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3311
Country	:	US
Telephone Number	:	310-248-6719
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	01/17/2026

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Directions to “ JAKOB PARK ” Practice Location

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