Michelle Myoungwoo Park, NP, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95002767 Issued in CA

Practice address

3075 Adeline St Ste 280
Berkeley, CA 94703-2580

Phone

(510) 981-4100

NPI assigned

Aug 19, 2015

Last updated

Aug 16, 2021By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Interoperability endpoints

• Direct secure messaging: mpark19585@smch.direct-ci.com
• Direct secure messaging: michelle.park@398008301912068.direct.elationemr.com

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1346616745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CORPORATE POINTE",
            "address_2": "STE 465",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902308706",
            "telephone_number": "510-981-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 ADELINE ST STE 280",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032580",
            "telephone_number": "510-981-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MICHELLE",
        "middle_name": "MYOUNGWOO",
        "credential": "NP, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "847491",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "87621",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95002767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ilya Parizhsky, MFT
• Annie Park, RPH
• Jung Sun Park, D.D.S.
• Katherine Sumin Park, RN
• Kristen Park
• Parker Focht Inc. (Berkeley Hearing Aid Center)
• Ann L. Parker, MD
• Kenneth Roy Parker, PH.D.
• Nikia Parker
• Kelli Parnall, OTR/L

• Family Nurse Practitioner in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.