Provider Demographics
NPI:1871520601
Name:PARK, SUNMIN (MD)
Entity type:Individual
Prefix:
First Name:SUNMIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2637
Mailing Address - Country:US
Mailing Address - Phone:213-736-0010
Mailing Address - Fax:213-736-0020
Practice Address - Street 1:2727 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2637
Practice Address - Country:US
Practice Address - Phone:213-736-0010
Practice Address - Fax:213-736-0020
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG074656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74656AMedicare ID - Type UnspecifiedMEDICARE PROVIDER
CAG74656Medicare ID - Type UnspecifiedMEDICARE PROVIDER