Individual provider Active NPI

Siin Park, MD

  • Student in an Organized Health Care Education/Training Program
  • Baltimore, MD
National Provider Identifier
1235870494
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
34755821 Issued in TX
Practice address
1800 Orleans St
Baltimore, MD 21287-0010
Phone
(443) 578-3181
NPI assigned
Apr 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 34755821 TX Primary

Addresses

Primary practice location

1800 Orleans St
Baltimore, MD 21287-0010

Mailing address

2401 S 31St St # Ms 22117D
Temple, TX 76508-0001
Phone (254) 724-1768

Other practice location 1

1741 Ashland Ave
Baltimore, MD 21205-1531
Phone (443) 923-9200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220601000341 TX Order and Referring Only - PsychiatryPractitioner - Psychiatry 8921486176

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34755821TXMDStudent in an Organized Health Care Education/Training Program

Interoperability endpoints

  • Direct secure messaging: spark44008@direct.kennedykrieger.org
  • Direct secure messaging: spark336101@direct.sw.org

NPI Registry JSON

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

{
    "created_epoch": "1648944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1235870494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST # MS 22117D",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-1768",
            "fax_number": "254-724-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 ORLEANS ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870010",
            "telephone_number": "443-578-3181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1741 Ashland Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212051531",
            "country_code": "US",
            "telephone_number": "443-923-9200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SIIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-03",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "34755821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.