Active NPI
Jae Young Park, ACUPUNCTURIST
- Acupuncturist
- Fort Gordon, GA
National Provider Identifier
1023199924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 11226
- Practice address
- 300 W Hospital Rd BLDG 3006TH
Interdisciplinary Pain Management Center
Fort Gordon, GA 30905-5741 - Phone
- (706) 787-0716
- Fax
- (706) 787-0196
- NPI assigned
- Oct 18, 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 11226 | CA | Primary |
Addresses
Primary practice location
300 W Hospital Rd BLDG 3006TH
Interdisciplinary Pain Management Center
Fort Gordon, GA 30905-5741
Mailing address
300 Hospital Rd
Interdisciplinary Pain Management Center
Fort Gordon, GA 30905-5741
Phone (706) 787-8322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11226 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438041600000",
"number": "1023199924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 HOSPITAL RD",
"address_2": "INTERDISCIPLINARY PAIN MANAGEMENT CENTER",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-787-8322",
"fax_number": "706-787-0196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD BLDG 3006TH",
"address_2": "INTERDISCIPLINARY PAIN MANAGEMENT CENTER",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-787-0716",
"fax_number": "706-787-0196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JAE",
"middle_name": "YOUNG",
"name_prefix": "Dr.",
"credential": "ACUPUNCTURIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2015-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "11226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.