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Kerry Park, MD
Specialist in Los Angeles, California
NPI 1962497149

Kerry Park is a Specialist based in Los Angeles, CA. Kerry Park practices in Los Angeles, CA and has the professional credentials of MD. The NPI Number for Kerry Park is 1962497149 and holds a License No. G77252 (California).

The current practice location address for Kerry Park is 1005 E Washington Blvd, Los Angeles, CA and can be reached out via phone at 323-233-3100 and via fax at 323-233-4100.

Location: 1005 E Washington Blvd, Los Angeles, CA, 90011-2023
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1962497149
Provider Name
Kerry Park
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1005 E Washington Blvd, Los Angeles, CA, 90011-2023
Phone Number
323-233-3100
Fax Number
323-233-4100
Provider Enumeration Date
09/14/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
522355131 01 CA TAX ID #
00G772520 05 CA
G39493 01 CA PTAN
institution
Provider Business Practice Location Address Details
Address
1005 E Washington Blvd
City
Los Angeles
State
California
Zip
90021-3020
Phone Number
323-233-3100
Fax Number
323-233-4100
person
Provider Business Mailing Address Details
Address
1005 E Washington Blvd
City
Los Angeles
State
California
Zip
90021-3020
Phone Number
323-233-3100
Fax Number
323-233-4100
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
G77252 (California)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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