Haeli Park, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A163831 Issued in CA

Practice address

975 S Fairmont Ave
Lodi, CA 95240-5118

Phone

(209) 339-7639

NPI assigned

Mar 27, 2018

Last updated

Aug 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Pediatrics

  Medicare reassignment NPD
• Regents of the Univ of Ca

  • Maternal & Fetal Medicine Physician
  • Sacramento, CA
  • NPI 1013906973
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Pediatrics

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Regents of the Univ of Ca

  • Diagnostic Radiology Physician
  • Sacramento, CA
  • NPI 1477546406
  NPD
• Regents of the University of Ca

  • Pediatrics Physician
  • Sacramento, CA
  • NPI 1386637346
  NPD
• Regents of the Univ of Ca

  • Pulmonary Disease Physician
  • Sacramento, CA
  • NPI 1437142692
  NPD (past)

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627776000000",
    "number": "1114422631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 STOCKTON BLVD STE 1700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172202",
            "telephone_number": "209-339-7639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405118",
            "telephone_number": "209-339-7639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "HAELI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-27",
        "last_updated": "2021-08-01",
        "certification_date": "2021-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A163831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Elizabeth Palmer, M.S. CCC-SLP
• Pornpit Nit Paluch, LVN
• Brenden F Panzarello, MD
• Alyssa Victoria Paquin
• Lisa Paradis, R.D.
• Janice Park, DMD
• Lidia Park
• Harpreet Singh Parmar, MD
• Jose Duarte Parra, M.D.
• Helen Pascua

• Pediatrics Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2021; 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.

Verify at the official NPI Registry.