Organization
MEDICAL PARK FAMILY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH FONG (ADMINISTRATOR)
(907) 257-8121
Entity
Organization
Contact information
Practice address
2211 E NORTHERN LIGHTS BLVD, ANCHORAGE, AK 99508-4103
(907) 257-8486
(907) 677-5614
Mailing address
2211 E NORTHERN LIGHTS BLVD, ANCHORAGE, AK 99508
(907) 279-8486
(907) 677-5614
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02D0864632
CLIA
AK
05
—
1004348
—
AK
01
—
KOOOOWCHKZ
MEDICARE
AK
Enumeration date
11/14/2006
Last updated
07/25/2024
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