Tae K Park, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

152709 Issued in NY

Practice address

724 8TH Ave
Brooklyn, NY 11215-4204

Phone

(718) 768-8111

Fax

(718) 768-8111

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Shin Yu, M.D., P.C.

  • Internal Medicine Physician
  • Ridgewood, NY
  • NPI 1720314594
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1336230259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 8TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112154204",
            "telephone_number": "718-768-8111",
            "fax_number": "718-768-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 8TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112154204",
            "telephone_number": "718-768-8111",
            "fax_number": "718-768-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "TAE",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "152709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00775604",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sai Chang Park, M.D.
• Sejin Park, NP
• Seungman Park, L.AC.
• Sowoon Park, LCSW
• Sun Hyee Park, PHARMD
• William Park
• Youngjun Park, MD
• Youngsun Park
• Youngwoo Park, DO
• Diana Parkansky, M.A.

• Hematology & Oncology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Hematology & Oncology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.