Active NPI
Kyong Bin Park, M.D.
- Internal Medicine Physician
- Havertown, PA
National Provider Identifier
1023036134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD056941L
- Practice address
- 525 W Chester Pike
Suite 102-B
Havertown, PA 19083-4539 - Phone
- (610) 853-9328
- Fax
- (610) 853-9336
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD056941L | PA | Primary |
Addresses
Primary practice location
525 W Chester Pike
Suite 102-B
Havertown, PA 19083-4539
Mailing address
525 W Chester Pike
Suite 102-B
Havertown, PA 19083-4500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001597486 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060228000019 | PA | Practitioner - Internal Medicine | 9335155449 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Saint Louis University School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Jefferson University Physicians
Practice addresses (Care Compare)
1101 Market St
FL 19
Philadelphia, PA 19107-2926
925 Chestnut St
Suite 3
Philadelphia, PA 19107-4216
Phone (215) 955-8874
Hospital & facility affiliations
- Bryn Mawr Hospital
- Main Line Hospital Lankenau
- Hospital of Univ of Pennsylvania
- Thomas Jefferson University Hospital
- Jefferson Stratford Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD056941L | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson University Physicians | Internal Medicine | Current | Accepting new patients |
| Jefferson University Physicians | Past | Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
525 W Chester Pike
Ste 102B
Havertown, PA 19083
Phone (610) 853-9328
925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760
Organizations & group practices 4
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.
-
- General Practice Physician
- Philadelphia, PA
- NPI 1326093675
Internal Medicine, PA
-
- Dermatology Physician
- Greenville, DE
- NPI 1295011419
-
- Gastroenterology Physician
- Phila, PA
- NPI 1205898723
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Philadelphia, PA
- NPI 1215916002
Hospital
-
- General Acute Care Hospital
- Philadelphia, PA
- NPI 1851370910
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404777600000",
"number": "1023036134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 W CHESTER PIKE",
"address_2": "SUITE 102-B",
"city": "HAVERTOWN",
"state": "PA",
"postal_code": "190834500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 W CHESTER PIKE",
"address_2": "SUITE 102-B",
"city": "HAVERTOWN",
"state": "PA",
"postal_code": "190834539",
"telephone_number": "610-853-9328",
"fax_number": "610-853-9336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KYONG BIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2014-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD056941L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001597486",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Havertown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.