Stanley S. Park, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD0000013517 Issued in TN

Practice address

5300 Clinton Plaza Drive
Knoxville, TN 37912-3830

Phone

(865) 688-7563

Fax

(865) 688-6252

NPI assigned

Dec 22, 2006

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

Other identifiers 1

Other names 1

• Dr. Soung-Ho Park Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1235294943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 CLINTON PLAZA DRIVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379123830",
            "telephone_number": "865-688-7563",
            "fax_number": "865-688-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 CLINTON PLAZA DRIVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379123830",
            "telephone_number": "865-688-7563",
            "fax_number": "865-688-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "STANLEY",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD0000013517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3190065",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOUNG-HO",
            "last_name": "PARK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christy C. Park, MD
• Deanna Park
• Emma Ruth Park, DNP
• Liliane Park
• Melinda Jo Park, PT/ATC
• Parker & Parker DDS PA
• Parker Therapy Services PLLC
• Abigail Wilson Parker, PA-C
• Amanda N Parker
• Andrew Louis Parker

• Pediatrics Physician in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.