Active NPI
Nanjin Jasmine Park, DPM
- Podiatrist
- Portland, OR
National Provider Identifier
1265743090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- DP125843
- Practice address
- 5311 SW Baird St
Portland, OR 97219-5023 - Phone
- (503) 894-1690
- NPI assigned
- Jun 26, 2010
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | DP125843 | OR | Primary |
| Podiatrist | 213E00000X | PO60075502 | WA |
Addresses
Primary practice location
5311 SW Baird St
Portland, OR 97219-5023
Mailing address
5311 SW Baird St
Portland, OR 97219-5023
Phone (503) 894-1690
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DP125843 | OR | MD | Podiatrist |
| PO60075502 | WA | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359417600000",
"number": "1265743090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5311 SW BAIRD ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972195023",
"telephone_number": "503-894-1690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5311 SW BAIRD ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972195023",
"telephone_number": "503-894-1690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "NANJIN",
"middle_name": "JASMINE",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-26",
"last_updated": "2013-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "OR",
"license": "DP125843",
"primary": true
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "WA",
"license": "PO60075502",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.