| Richard Park M.d., A Professional Corporation | |
|
10515 Balboa Blvd Ste 325 Granada Hills CA 91344-6364 | |
| (818) 678-9875 | |
| (747) 200-2589 |
| Full Name | Richard Park M.d., A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 10515 Balboa Blvd Ste 325, Granada Hills, California |
| Authorized Official Name and Position | Richard Park (CEO/PHYSICIAN) |
| Authorized Official Contact | 8186789875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Park M.d., A Professional Corporation 2709 Rocky Point Ct Thousand Oaks CA 91362-4943 Ph: (805) 368-1293 | Richard Park M.d., A Professional Corporation 10515 Balboa Blvd Ste 325 Granada Hills CA 91344-6364 Ph: (818) 678-9875 |
| NPI Number | 1982946323 |
|---|---|
| Provider Enumeration Date | 03/25/2013 |
| Last Update Date | 04/09/2024 |
| Medicare PECOS PAC ID | 2163643966 |
|---|---|
| Medicare Enrollment ID | O20141020002638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982946323 | NPI | - | NPPES |
| Provider Name | Richard Park |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174718134 PECOS PAC ID: 5698964906 Enrollment ID: I20110118000516 |
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