Active NPI
Heran Angela Park, MD
- Pediatrics Physician
- Orange, CA
National Provider Identifier
1023107505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G67916
- Practice address
- 4010 E Chapman Ave Ste C
Orange, CA 92869-3990 - Phone
- (714) 500-0360
- Fax
- (714) 532-3943
- NPI assigned
- Oct 12, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G67916 | CA | Primary |
Addresses
Primary practice location
4010 E Chapman Ave Ste C
Orange, CA 92869-3990
Mailing address
4010 E Chapman Ave Ste C
Orange, CA 92869-3990
Phone (714) 500-0360
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G679160 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20121016000338 | CA | Order and Referring Only - Family Practice | 1052576634 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301011200000",
"number": "1023107505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 E CHAPMAN AVE STE C",
"city": "ORANGE",
"state": "CA",
"postal_code": "928693990",
"telephone_number": "714-500-0360",
"fax_number": "714-532-3943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 E CHAPMAN AVE STE C",
"city": "ORANGE",
"state": "CA",
"postal_code": "928693990",
"telephone_number": "714-500-0360",
"fax_number": "714-532-3943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "HERAN",
"middle_name": "ANGELA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-12",
"last_updated": "2011-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G67916",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G679160",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.