Individual provider Active NPI

Sho Park, FNP-BC

  • Family Nurse Practitioner
  • Kapolei, HI
National Provider Identifier
1225577661
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN-3493 Issued in HI
Practice address
599 Farrington Hwy Ste 201
Kapolei, HI 96707-2028
Phone
(808) 691-7338
NPI assigned
Feb 17, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ00812200 NJ
Registered Nurse 163W00000X 22 714607 NY
Family Nurse Practitioner 363LF0000X 95013080 CA
Family Nurse Practitioner 363LF0000X APRN-3493 HI Primary

Addresses

Primary practice location

599 Farrington Hwy Ste 201
Kapolei, HI 96707-2028

Mailing address

599 Farrington Hwy Ste 201
Kapolei, HI 96707-2028
Phone (808) 691-7338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220407002165 HI Practitioner - Nurse Practitioner 8527314566 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Queens University Medical GroupGroup PAC ID 2466831557, 614 clinicians

Practice addresses (Care Compare)

599 Farrington Hwy
Suite 201
Kapolei, HI 96707-2028
Phone (808) 691-7338

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
22 714607NYMDRegistered Nurse
APRN-3493HIMDFamily Nurse Practitioner
26NJ00812200NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Queen's Medical Center CurrentSince Mar 30, 2022 Accepting new patients
The Queen's Medical Center Current Accepting new patients
Queens University Medical Group CurrentSince Jul 1, 2022 Accepting new patients
The Queens Medical Center CurrentSince Mar 30, 2022 Accepting new patients

Locations

550 S Beretania St
Ste 404
Honolulu, HI 96813
Phone (808) 691-8897

1380 Lusitana St
Ste 913
Honolulu, HI 96813
Phone (808) 691-8521

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

599 Farrington Hwy
Ste 201
Kapolei, HI 96707
Phone (808) 674-9500

Networks

  • devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1225577661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 FARRINGTON HWY STE 201",
            "city": "KAPOLEI",
            "state": "HI",
            "postal_code": "967072028",
            "telephone_number": "808-691-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 FARRINGTON HWY STE 201",
            "city": "KAPOLEI",
            "state": "HI",
            "postal_code": "967072028",
            "telephone_number": "808-691-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SHO",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-17",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00812200",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "22 714607",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013080",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "HI",
            "license": "APRN-3493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kapolei, HI

Sources for this page

Verify at the official NPI Registry.