Individual provider Active NPI

Sang Hyoung Park, MD

  • Student in an Organized Health Care Education/Training Program
  • Rochester, MN
National Provider Identifier
1073043105
Registry record updated Jun 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
200 1St St SW
Rochester, MN 55905-0001
Phone
(507) 284-2511
NPI assigned
Jun 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

200 1St St SW
Rochester, MN 55905-0001

Mailing address

122 Avalon Cove Cir NW
Rochester, MN 55901-8495

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28770MNMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497225600000",
    "number": "1073043105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 AVALON COVE CIR NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559018495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SANG HYOUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-12",
        "last_updated": "2017-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.