Active NPI
Jung I. Park, M.D.
- Specialist
- Munster, IN
National Provider Identifier
1124006523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 01032400A
- Practice address
- 8825 Crestwood Ave
Munster, IN 46321-2711 - Phone
- (219) 746-9600
- NPI assigned
- Jan 5, 2006
- 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 | 01032400A | IN | Primary |
Addresses
Primary practice location
8825 Crestwood Ave
Munster, IN 46321-2711
Mailing address
8825 Crestwood Ave
Munster, IN 46321-2711
Phone (219) 746-9600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 234393 | Medicaid | IN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01032400A | IN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366329600000",
"number": "1124006523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8825 CRESTWOOD AVE",
"city": "MUNSTER",
"state": "IN",
"postal_code": "463212711",
"telephone_number": "219-746-9600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8825 CRESTWOOD AVE",
"city": "MUNSTER",
"state": "IN",
"postal_code": "463212711",
"telephone_number": "219-746-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JUNG",
"middle_name": "I.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-05",
"last_updated": "2013-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IN",
"license": "01032400A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "234393",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Munster, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.