Organization
BACK TO WORK ORTHOPEDIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN PARK (MD)
(562) 802-0208
Entity
Organization
Contact information
Practice address
15330 VALLEY VIEW AVE STE 1, LA MIRADA, CA 90638-5238
(562) 802-0208
Mailing address
15330 VALLEY VIEW AVE STE 1, LA MIRADA, CA 90638-5238
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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