MEDICARE: DAVID 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	122300000X	Dentist	109001	CA

General Provider Information

NPI Number	:	1891482337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PARK

Provider Business Mailing Address
First Line	:	3150 WILSHIRE BLVD APT 2514
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1370
Country	:	US
Telephone Number	:	661-476-2009
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 WILSHIRE BLVD APT 2514
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1370
Country	:	US
Telephone Number	:	661-476-2009
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	02/20/2025

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Directions to “ DAVID PARK ” Practice Location

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