Joong Y Park, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A39059 Issued in CA

Practice address

3511 W Olympic BL
#101
Los Angeles, CA 90019

Phone

(323) 766-1057

Fax

(323) 766-8790

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: joong.park@350281541025796.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Joong Young Park M.D. Inc.

  • General Practice Physician
  • Garden Grove, CA
  • NPI 1104014034
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291593600000",
    "number": "1003839002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3511 W OLYMPIC BL",
            "address_2": "#101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90019",
            "telephone_number": "323-766-1057",
            "fax_number": "323-766-8790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3511 W OLYMPIC BL",
            "address_2": "#101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90019",
            "telephone_number": "323-766-1057",
            "fax_number": "323-766-8790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOONG",
        "middle_name": "Y",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2010-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A39059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A390590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jooha Park
• Joon Park
• Joon Suk Park, M.D.
• Joon Woo Park, DMD
• Joon Y Park, PT
• Jooyeon Park
• Joseph Park, CPO
• Joy H. Park, PHARM.D.
• Ju Hea Park, ACSW
• Julie H. Park, MD

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.