Active NPI
Ji Yoon Park, M.D.
- Student in an Organized Health Care Education/Training Program
- Charleston, WV
National Provider Identifier
1306535661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3200 Maccorkle Avenue Southeast
Camc Memorial Hospital Internal Medicine
Charleston, WV 25304 - Phone
- (304) 388-5590
- Fax
- (304) 388-8238
- NPI assigned
- May 3, 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
3200 Maccorkle Avenue Southeast
Camc Memorial Hospital Internal Medicine
Charleston, WV 25304
Mailing address
150, Buheung-Ro, , Bucheon-Si Gyeonggip-DO, Republic of
Sarang Apt 1612-1402
Bucheon-Si, GYEONGGI-DI 14600
KR
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230925003478 | WV | Order and Referring Only - Internal Medicine | 1254785264 |
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": "1683072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1306535661",
"addresses": [
{
"country_code": "KR",
"country_name": "Korea, Republic of",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "150, BUHEUNG-RO, , BUCHEON-SI GYEONGGIP-DO, REPUBLIC OF",
"address_2": "SARANG APT 1612-1402",
"city": "BUCHEON-SI",
"state": "GYEONGGI-DI",
"postal_code": "14600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVENUE SOUTHEAST",
"address_2": "CAMC MEMORIAL HOSPITAL INTERNAL MEDICINE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "25304",
"telephone_number": "304-388-5590",
"fax_number": "304-388-8238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JI YOON",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-03",
"last_updated": "2023-08-15",
"certification_date": "2023-05-08",
"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": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.