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NICHOLAS PARK
NPI 1346932324
Student in an Organized Health Care Education/Training Program in Los Angeles, CA

Active since May 25, 2023PECOS Enrolled
1720 E CESAR E CHAVEZ AVE, LOS ANGELES, CA 90033(323) 260-5789 Get Directions Write a Review

NPPES record last updated: April 10, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 10, 2025, May 25, 2023 (2 updates tracked since 2023).

About Nicholas Park NPPES

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

NICHOLAS PARK (NPI 1346932324) is an individual student in an organized health care education/training program in Los Angeles, California and active in the NPI registry since May 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1346932324
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameNICHOLAS PARK
Location Address1720 E CESAR E CHAVEZ AVELos Angeles, CA 90033-2414
Mailing Address1720 E Cesar E Chavez AveLos Angeles, CA 90033-2414 · (323) 260-5789
Phone(323) 260-5789
Sole ProprietorNo
Enumeration DateMay 25, 2023
Last NPPES UpdateApril 10, 20252 updates tracked since enumeration
NPPES CertifiedApril 10, 2025
✔ NPI 1346932324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1720 E CESAR E CHAVEZ AVE, Los Angeles, CA 90033
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicholas Park is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. NAYELI BUENROSTRO DPM
Student in an Organized Health Care Education/Training Program
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (323) 268-5000
PARDIS A SAFFARI DO
Internal Medicine
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (323) 260-5781
AH YEON CHANG RN
Registered Nurse (Case Management)
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (323) 268-5000
JOSIF BOROVIC, MD, INC
Pain Medicine (Interventional Pain Medicine)
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (562) 407-2080
CONNIE CHUNG MD
Student in an Organized Health Care Education/Training Program
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (323) 260-5781
DAVINA RENE HSU D.O.
Family Medicine
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (323) 268-5000
STELLA MARIE GOMORY PA-C
Physician Assistant
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (323) 268-5000
MARYAM FAKHRAI
Obstetrics & Gynecology
1720 E CESAR E CHAVEZ AVE
LOS ANGELES, CA 90033
Los Angeles County (949) 510-4227

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 Nicholas Park's NPI number?

The NPI number for Nicholas Park is 1346932324. It was assigned to this individual provider in the NPPES registry on May 25, 2023.

Where is Nicholas Park located?

Nicholas Park practices at 1720 E Cesar E Chavez Ave, Los Angeles, CA 90033. The listed phone number is (323) 260-5789.

What is Nicholas Park's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Nicholas Park enrolled in Medicare?

Yes. Nicholas Park is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nicholas Park was last updated on April 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.