Nathaniel Jeong Su Park

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH80055 Issued in CA

Practice address

100 China Grade Loop
Bakersfield, CA 93308-1739

Phone

(661) 393-3358

NPI assigned

Jan 10, 2019

Last updated

Jan 10, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Omganesh Corporation

  dba Clinica Pharmacy

  • Community/Retail Pharmacy
  • Delano, CA
  • NPI 1265011639
  NPD Authorized official
• Krishnaom Corporation

  dba Niles Care Pharmacy

  • Community/Retail Pharmacy
  • Bakersfield, CA
  • NPI 1376297531
  NPD
• Thrifty Payless Inc

  dba Rite Aid Pharmacy 05815

  • Community/Retail Pharmacy
  • Bakersfield, CA
  • NPI 1033120332
  NPD (past)
• Thrifty Payless Inc

  dba Rite Aid Pharmacy 06833

  • Community/Retail Pharmacy
  • Winchester, CA
  • NPI 1437874062
  NPD (past)

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1194298257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 JEWETTA AVE APT H10",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933125490",
            "telephone_number": "213-284-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CHINA GRADE LOOP",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933081739",
            "telephone_number": "661-393-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "NATHANIEL",
        "middle_name": "JEONG SU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "RPH80055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne J Park, RPH
• Jonathan Michael Park
• Kiefer Sungwhan Park, DDS
• Kyoung Hee Park
• Kyung Choon Park, O.D.
• Woori Park
• Yong Eon Park, DDS
• Young Wu Park, MD
• Amanda Brooke Parker Trautmann, LCW
• Courtney Parker

• Pharmacist in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.