Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 226240 | MA |
Y | 207YS0123X | Facial Plastic Surgeon | A112280 | CA |
NPI | 1871717140 |
---|---|
Provider Name | Aric Kihyun Park |
First Address | Beverly Hills, CA 90212-2202 |
Second Address | Beverly Hills, CA 90212-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 07/08/2013 |