Provider Demographics
NPI:1992806038
Name:PARK, ALANE (MD)
Entity type:Individual
Prefix:DR
First Name:ALANE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12930 VENTURA BLVD
Mailing Address - Street 2:#643
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2200
Mailing Address - Country:US
Mailing Address - Phone:213-294-2160
Mailing Address - Fax:213-294-2165
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-294-2160
Practice Address - Fax:213-294-2165
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA62956207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93552Medicare UPIN