DR. KERRI SHANE PARKS M.D. NPI 1104893775

NPI Information

  • NPI: 1104893775
  • Provider Name: DR. KERRI SHANE PARKS, M.D.
  • Classification: Specialist - 174400000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1808 VERDUGO BLVD
    SUITE 208
    GLENDALE, CA
    ZIP 91208
  • Phone: (818) 952-5322

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NPI Details

DR. Kerri Shane Parks, M.D. is a specialist in Glendale, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. Kerri Shane Parks, M.D. NPI is 1104893775. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1808 VERDUGO BLVD
SUITE 208
GLENDALE, CA
ZIP 91208-477
Phone: (818) 952-5322
Fax: (818) 952-7993

The NPI 1104893775 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/2/2006 and was last updated on 12/7/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistA65496CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1WA65496DMEDICARE UPINCALIFORNIA
2GR0102260MEDICAIDCALIFORNIA
3H31405MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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