Park, Joe

Park, Joe is an individual health care provider with primary practice located at 15447 W Sand St , Victorville CA 92392-2904. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Park, Joe can be contacted via phone (760) 843-9679.

Contact Information

Primary practice address
15447 W Sand St Victorville CA 92392-2904
Phone: (760) 843-9679
Fax: (760) 245-3618
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X A86588 California
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X A86588 California
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X A86588 California

Profile Details

NPI number 1083645832
LBN Legal business name Park, Joe
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Mar 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083645832 NPPES
California MEDICAID 00A865880

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