Active NPI
Jin Sook Park
- Physical Therapist
- Redwood City, CA
National Provider Identifier
1255548343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT22150
- Practice address
- 630 Hillcrest Dr
Redwood City, CA 94062 - Phone
- (408) 829-8482
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 2532 | HI | |
| Physical Therapist | 225100000X | PT22150 | CA | Primary |
Addresses
Primary practice location
630 Hillcrest Dr
Redwood City, CA 94062
Mailing address
630 Hillcrest Dr
Redwood City, CA 94062-3066
Phone (408) 829-8482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT22150 | CA | MD | Physical Therapist |
| PT 2532 | HI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530835200000",
"number": "1255548343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 HILLCREST DR",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940623066",
"telephone_number": "408-829-8482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 HILLCREST DR",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "94062",
"telephone_number": "408-829-8482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JIN",
"middle_name": "SOOK",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2018-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "PT 2532",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT22150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.