Provider Demographics
NPI:1871717140
Name:PARK, ARIC KIHYUN (MD)
Entity type:Individual
Prefix:
First Name:ARIC
Middle Name:KIHYUN
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 N LINDEN DR STE 240
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2202
Mailing Address - Country:US
Mailing Address - Phone:310-247-0718
Mailing Address - Fax:
Practice Address - Street 1:462 N LINDEN DR STE 240
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2202
Practice Address - Country:US
Practice Address - Phone:310-247-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226240207Y00000X
CAA112280207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology