KERRY PARK (NPI# 1962497149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962497149 |
| Entity Type | Individual |
| Full Name | KERRY PARK |
| Credential | M.D. |
| Practice Address |
1005 E Washington Blvd Suite A-1 Los Angeles CA 90021-3020 |
| Mailing Address |
2801 S San Pedro St Los Angeles CA 90011-2023 |
| Practice Telephone | 3232333100 |
| Practice Fax Number | 3232334100 |
| Mailing Telephone | 3232333100 |
| Mailing Fax Number | 3232334100 |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2019-04-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | G77252 | CA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | PTAN | G39493 | 01 |
| CA | TAX ID # | 522355131 | 01 |
| CA | 00G772520 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154592590 | Kerry Max Park | Marriage & Family Therapist | 21 N 490 W, American Fork, UT 84003-2264 | 2008-03-13 |
| Street Address |
1005 E WASHINGTON BLVD SUITE A-1 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90021-3020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659366136 | Hector Castillo | Specialist | 1005 E Washington Blvd, Los Angeles, CA 90021-3020 | 2005-09-12 |
| 1669968574 | Jessica Flores | Physician Assistant | 1005 E Washington Blvd, Los Angeles, CA 90021-3068 | 2018-07-03 |
| 1912325051 | Diana Carolina Cantero | Physician Assistant | 1005 E Washington Blvd, Los Angeles, CA 90021-3020 | 2014-04-05 |
| 1093023277 | Universal Community Health Center | Family Medicine | 1005 E Washington Blvd, Suite A, Los Angeles, CA 90021-3020 | 2010-09-21 |
| 1336311539 | Kp Medical Corporation | Specialist | 1005 E Washington Blvd, Suite A-1, Los Angeles, CA 90021-3020 | 2008-03-27 |
| 1912182684 | Alfa Allied Medical Group Inc | Family Medicine | 1005 E Washington Blvd, Los Angeles, CA 90021-3020 | 2007-12-31 |
| 1962697219 | Agustin Jaime Lara | Family Medicine | 1005 E Washington Blvd, Ste A, Los Angeles, CA 90021-3020 | 2007-09-10 |
| 1306831870 | Apc Medical Group, Inc. | Specialist | 1005 E Washington Blvd, #a, Los Angeles, CA 90021-3020 | 2005-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386104222 | Para Los Ninos | Community/Behavioral Health | 835 Stanford Avenue, Los Angeles, CA 90021 | 2019-03-25 |
| 1750826293 | Dion David Thomas | Counselor | 600 E 7th Street #105, Los Angeles, CA 90021 | 2016-12-19 |
| 1255713921 | Stephanie Castillo | Counselor | 453 S. Indiana St., Los Angeles, CA 90021 | 2015-06-18 |
| 1700217437 | Gabriela Turcios | Counselor | 2116-2118 S. Central Ave, Los Angeles, CA 90021 | 2013-12-05 |
| 1033456934 | Brenda Denise Perez | Counselor | 838 Est. 6th Treet, Los Angeles, CA 90021 | 2013-01-11 |
| 1083885370 | Dina Moss | Rehabilitation Practitioner | 921 Compton Blv, Compton, CA 90021 | 2008-03-14 |
| 1760692339 | Deanna Perez | Physician Assistant | 515 E. 6th Street, Los Angeles, CA 90021 | 2007-05-23 |
| 1033322573 | Nguyen Trong Doan | Physician Assistant | 1663 Beverly Blvd., #201, Los Angeles, CA 90021 | 2007-05-08 |
| 1740834258 | Janette Lozada | Counselor | 849 E 6th St, Los Angeles, CA 90021 | 2019-08-01 |
| 1588166789 | Roseanna Low | Counselor | 905 E 8th St, Los Angeles, CA 90021 | 2018-03-02 |
| Find all providers in zip 90021 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| 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. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255801098 | Maria Elizabeth Botham | Specialist | 8250 W 3rd St Ste 203, Los Angeles, CA 90048-4327 | 2018-12-04 |
| 1154899821 | Adam Garcia-morales | Specialist | 216 S Townsend Ave, Los Angeles, CA 90063-2439 | 2018-11-11 |
| 1174028930 | Sabrena Anne Smith | Specialist | 1680 Vine St Ste 908, Los Angeles, CA 90028-8838 | 2018-03-26 |
| 1538663513 | John Horton | Specialist | 760 Westwood Plaza, Resident Office, Los Angeles, CA 90024 | 2018-03-22 |
| 1598272262 | Ronna Lynne Pearl | Specialist | 3371 Glendale Blvd Ste 215, Los Angeles, CA 90039-1857 | 2018-01-04 |
| 1245754431 | Marla Ellen Mintz | Specialist | 11844 W Pico Blvd Ste 200, Los Angeles, CA 90064-1353 | 2017-07-28 |
| 1730619818 | Emily Ng | Specialist | 8590 W Pico Blvd, Los Angeles, CA 90035-2691 | 2017-06-12 |
| 1871044297 | Katherinne Aucaruri | Specialist | 4225 Blanchard St, Los Angeles, CA 90063-1317 | 2016-10-20 |
| 1720536923 | Jkc Neurology Medical Group Inc | Specialist | 3550 Wilshire Blvd Ste 650, Los Angeles, CA 90010-2440 | 2016-09-15 |
| 1932552916 | Anthony Jose Salvatierra | Specialist | 421 S Manhattan Pl Apt 9, Los Angeles, CA 90020-4175 | 2016-07-14 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90021 |
Please comment or provide details below to improve the information on KERRY PARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.