Active NPI
Moon Soo Park, M.D.
- Specialist
- Hilo, HI
National Provider Identifier
1104084912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 2093
- Practice address
- 33 Lanihuli St
Hilo, HI 96720-4142 - Phone
- (808) 935-4814
- Fax
- (808) 935-2518
- NPI assigned
- May 29, 2008
- Last updated
- May 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 2093 | HI | Primary |
Addresses
Primary practice location
33 Lanihuli St
Hilo, HI 96720-4142
Mailing address
33 Lanihuli St
Hilo, HI 96720-4142
Phone (808) 935-4814
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2093 | HI | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Laboratories of Hawaii LLP | Past | Accepting new patients | |
| Pan Pacific Pathologists, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Medical Laboratory
- Aiea, HI
- NPI 1134195357
-
- Anatomic Pathology & Clinical Pathology Physician
- Aiea, HI
- NPI 1962479360
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212019200000",
"number": "1104084912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 LANIHULI ST",
"city": "HILO",
"state": "HI",
"postal_code": "967204142",
"telephone_number": "808-935-4814",
"fax_number": "808-935-2518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 LANIHULI ST",
"city": "HILO",
"state": "HI",
"postal_code": "967204142",
"telephone_number": "808-935-4814",
"fax_number": "808-935-2518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MOON",
"middle_name": "SOO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-29",
"last_updated": "2008-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "HI",
"license": "2093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.