Heejung Park, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R224697 Issued in MD

Practice address

1403 Madison Park Dr Ste 100
Glen Burnie, MD 21061-6292

Phone

(410) 582-9630

NPI assigned

Aug 18, 2023

Last updated

Aug 18, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shahab a Malik MD, LLC.

  • Pediatrics Physician
  • Glen Burnie, MD
  • NPI 1740329507
  NPD

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1326822669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7710 HEARTHSIDE WAY UNIT 408",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210757605",
            "telephone_number": "412-334-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 MADISON PARK DR STE 100",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616292",
            "telephone_number": "410-582-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "HEEJUNG",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R224697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manjiri M Pansare, M.D.
• Celia Parada-Worby, CNS
• Kenneth L Pardoe, PA
• Parents' Place of Maryland, Inc.
• Park Dental
• Jaewoo Park, DDS
• Joseph Choi Park, M.D.
• Justin Park, M.D.
• Kee Jong Park, M.D.
• Matthew Park, M.D.

• Pediatric Nurse Practitioner in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Pediatric Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.