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KERRY PARK M.D.
NPI 1962497149
Specialist in Los Angeles, CA

Active since September 14, 2005
1005 E WASHINGTON BLVD, SUITE A-1, LOS ANGELES, CA 90021(323) 233-3100(323) 233-4100 Get Directions Write a Review

NPPES record last updated: April 5, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kerry Park M.d. NPPES

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

KERRY PARK M.D. (NPI 1962497149) is an individual specialist in Los Angeles, California, licensed in California (G77252) and active in the NPI registry since September 2005.

NPPES Registry Identity

NPI1962497149
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameKERRY PARKCredential: M.D.
Location Address1005 E WASHINGTON BLVD, SUITE A-1Los Angeles, CA 90021-3020
Mailing Address2801 S San Pedro StLos Angeles, CA 90011-2023 · (323) 233-3100 · Fax (323) 233-4100
Phone(323) 233-3100
Fax(323) 233-4100
Sole ProprietorYes
Enumeration DateSeptember 14, 2005
Last NPPES UpdateApril 5, 2019
✔ NPI 1962497149 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · G77252
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1005 E WASHINGTON BLVD, Los Angeles, CA 90021
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Other Identifiers 3

OtherG39493CA · Ptan
Other522355131CA · Tax Id #
Medicaid00G772520CA

Other Providers at the Same Location NPPES 7

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

UNIVERSAL COMMUNITY HEALTH CENTER
Clinic/Center (Federally Qualified Health Center (FQHC))
1005 E WASHINGTON BLVD, SUITE A
LOS ANGELES, CA 90021
Los Angeles County (213) 745-3636
APC MEDICAL GROUP, INC.
Specialist
1005 E WASHINGTON BLVD, #A
LOS ANGELES, CA 90021
Los Angeles County (213) 745-3636
KP MEDICAL CORPORATION
Specialist
1005 E WASHINGTON BLVD, SUITE A-1
LOS ANGELES, CA 90021
Los Angeles County (213) 745-3636
LETICIA PEREZ
Physician Assistant
1005 E WASHINGTON BLVD
LOS ANGELES, CA 90021
Los Angeles County (323) 233-3100
DR. HECTOR CASTILLO M.D.
Specialist
1005 E WASHINGTON BLVD
LOS ANGELES, CA 90021
Los Angeles County (213) 745-3636
MS. JESSICA FLORES PA
Physician Assistant
1005 E WASHINGTON BLVD
LOS ANGELES, CA 90021
Los Angeles County (323) 233-3100
ALFA ALLIED MEDICAL GROUP INC
Family Medicine
1005 E WASHINGTON BLVD
LOS ANGELES, CA 90021
Los Angeles County (213) 745-3636

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 Kerry Park's NPI number?

The NPI number for Kerry Park is 1962497149. It was assigned to this individual provider in the NPPES registry on September 14, 2005.

Where is Kerry Park located?

Kerry Park practices at 1005 E Washington Blvd Suite A-1, Los Angeles, CA 90021. The listed phone number is (323) 233-3100.

What is Kerry Park's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Kerry Park was last updated on April 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.