Active NPI
Justin Jong-Gene Park, MD
- Student in an Organized Health Care Education/Training Program
- Irvine, CA
National Provider Identifier
1255034534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 71 Homeland
Irvine, CA 92618-8801 - Phone
- (949) 680-6284
- NPI assigned
- Mar 24, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
71 Homeland
Irvine, CA 92618-8801
Mailing address
71 Homeland
Irvine, CA 92618-8801
Other names 1
- Jong-Gene Park
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230808003819 | MA | Order and Referring Only - Internal Medicine | 6709248750 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679616000000",
"number": "1255034534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 HOMELAND",
"city": "IRVINE",
"state": "CA",
"postal_code": "926188801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 HOMELAND",
"city": "IRVINE",
"state": "CA",
"postal_code": "926188801",
"telephone_number": "949-680-6284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JUSTIN",
"middle_name": "JONG-GENE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-24",
"last_updated": "2023-03-24",
"certification_date": "2023-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JONG-GENE",
"last_name": "PARK",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.