Basic Information
| Provider Information | |||||||||
| NPI: | 1104226935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | EUGENE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N STATE ST RM 1060H | ||||||||
| Address2: | LAC-USC MEDICAL CENTER | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232262828 | ||||||||
| FaxNumber: | 3232266454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N STATE ST RM 1060H | ||||||||
| Address2: | LAC-USC MEDICAL CENTER | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232262828 | ||||||||
| FaxNumber: | 3232266454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A132213 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.