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WILSON H PARK, M.D.
NPI 1164639704
Internal Medicine in Los Angeles, CA

Active since May 16, 2007CLIA 05D1068559 · Waiver
3663 W 6TH ST, SUITE 100, LOS ANGELES, CA 90020(213) 383-4000(213) 427-5588 Get Directions Write a Review

NPPES record last updated: September 17, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Wilson H Park, M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WILSON H PARK, M.D. (NPI 1164639704) is a healthcare organization registered as an internal medicine in Los Angeles, California and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through May 14, 2027 and lists Wilson Ho Park, President, as its authorized official.

NPPES Registry Identity

NPI1164639704
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameWILSON H PARK, M.D.,INC.
Location Address3663 W 6TH ST, SUITE 100Los Angeles, CA 90020-3049
Mailing Address3663 W 6th St, Suite 100Los Angeles, CA 90020-3049 · (213) 383-4000 · Fax (213) 427-5588
Phone(213) 383-4000
Fax(213) 427-5588
Organization SubpartNo
Authorized OfficialWilson Ho ParkPresident · (213) 383-4000
Enumeration DateMay 16, 2007
Last NPPES UpdateSeptember 17, 2009
✔ NPI 1164639704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3663 W 6TH ST, Los Angeles, CA 90020
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Other Names 1

Other NameWilson H Park, M.d.

Other Identifiers 2

Other1194855627Npi Number
OtherG45867CA · State License Number

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wilson H Park, M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Wilson H Park, M.D., which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Hongnan Jhang, NP
Nurse Practitioner
NPI 1528728078
3663 W 6TH ST STE 100
Los Angeles, CA 90020
(213) 383-4000
✔ PECOSSame address
Wilson Park, MD
Internal Medicine
NPI 1194855627
3663 W 6TH ST SUITE 100
Los Angeles, CA 90020
(213) 383-4000
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1068559

Wilson H Park MD Inc · Los Angeles, CA
Active · expires May 14, 2027
CLIA Number05D1068559
Laboratory TypePhysician Office
Certificate Effective DateMay 15, 2025
Certificate Expiration DateMay 14, 2027
Laboratory DirectorWilson H. Park MD
Laboratory Phone(213) 383-4000
Laboratory LocationWilson H Park MD Inc3663 W 6th St # 100, Los Angeles, CA 90020
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wilson H Park, M.D.,inc.'s NPI number?

The NPI number for Wilson H Park, M.D.,inc. is 1164639704. It was assigned to this organization in the NPPES registry on May 16, 2007. The provider is also known as Wilson H Park, M.D..

Where is Wilson H Park, M.D.,inc. located?

Wilson H Park, M.D.,inc. is located at 3663 W 6th St Suite 100, Los Angeles, CA 90020. The listed phone number is (213) 383-4000.

What is Wilson H Park, M.D.,inc.'s specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Wilson H Park, M.D.,inc. enrolled in Medicare?

Yes. Wilson H Park, M.D.,inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Wilson H Park, M.D.,inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Wilson H Park, M.D.,inc., in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Wilson H Park, M.D.,inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1068559) is associated with this NPI, valid through May 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wilson H Park, M.D.,inc. was last updated on September 17, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.