# RICHARD PARK MEDICAL GROUP APC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386241040
- **Authorized official:** RICHARD PARK MD (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (818) 850-2960

## Contact information

- **Practice address:** 7535 LAUREL CANYON BLVD, NORTH HOLLYWOOD, CA 91605-3149
- **Practice address phone:** (818) 850-2960
- **Practice address fax:** (818) 747-2800
- **Mailing address:** 7535 LAUREL CANYON BLVD, NORTH HOLLYWOOD, CA 91605-3149
- **Mailing address phone:** (818) 850-2960
- **Mailing address fax:** (818) 747-2800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/06/2020
- **Last updated:** 10/06/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A111560 | MEDICAL LICENSE | CA |