Jongbae Jay Park, KMD, PHD, L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

490 Issued in NC

Practice address

1910 Sedwick Rd Ste 400a
Durham, NC 27713-9428

Phone

(919) 813-6636

NPI assigned

Jun 26, 2008

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1194987792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 SEDWICK RD STE 400A",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277139428",
            "telephone_number": "919-813-6636",
            "fax_number": "919-893-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 SEDWICK RD STE 400A",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277139428",
            "telephone_number": "919-813-6636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4822 Six Forks Rd",
            "address_2": "Suite 202",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276095269",
            "country_code": "US",
            "telephone_number": "919-724-9985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JONGBAE",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "KMD, PHD, L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NC",
            "license": "490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Ophthalmology
• Esther Yoo Hyun Park
• Eunee Kathleen Park, MD
• Hanna Park, FNP-BC
• John J W Park, MD
• Lisa Regina Park, AUD
• Nancy Park
• Jonathan David Parke, MD
• Tomaseina Javonnie Parker-Talib
• April Tripp Parker, MS, LCMHC

• Acupuncturist in Durham, NC
• Providers in Durham, NC by specialty
• Acupuncturist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; 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.