| Wilson H Park, M.d. | |
|
3663 W 6th St Suite 100 Los Angeles CA 90020-3049 | |
| (213) 383-4000 | |
| (213) 427-5588 |
| Full Name | Wilson H Park, M.d. |
|---|---|
| Speciality | Internal Medicine |
| Location | 3663 W 6th St, Los Angeles, California |
| Authorized Official Name and Position | Wilson Ho Park (PRESIDENT) |
| Authorized Official Contact | 2133834000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson H Park, M.d. 3663 W 6th St Suite 100 Los Angeles CA 90020-3049 Ph: (213) 383-4000 | Wilson H Park, M.d. 3663 W 6th St Suite 100 Los Angeles CA 90020-3049 Ph: (213) 383-4000 |
| NPI Number | 1164639704 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 09/17/2009 |
| Medicare PECOS PAC ID | 9830296862 |
|---|---|
| Medicare Enrollment ID | O20070525000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164639704 | NPI | - | NPPES |
| 1194855627 | Other | NPI NUMBER | |
| G45867 | Other | CA | STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Wilson H Park |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194855627 PECOS PAC ID: 6800871781 Enrollment ID: I20040623001261 |
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