Provider Demographics
NPI:1588723399
Name:PARK, HO SEONG (MD)
Entity type:Individual
Prefix:
First Name:HO
Middle Name:SEONG
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S VERMONT AVE
Mailing Address - Street 2:101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1584
Mailing Address - Country:US
Mailing Address - Phone:213-382-5420
Mailing Address - Fax:213-382-7404
Practice Address - Street 1:808 S VERMONT AVE
Practice Address - Street 2:101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1584
Practice Address - Country:US
Practice Address - Phone:213-382-5420
Practice Address - Fax:213-382-7404
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3631102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363110Medicaid