Active NPI
Soo Kyong Pak
- Pharmacist
- Flushing, NY
National Provider Identifier
1366921199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 064178
- Practice address
- 15015 Northern Blvd
Flushing, NY 11354-3885 - Phone
- (718) 888-0851
- NPI assigned
- Aug 13, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 064178 | NY | Primary |
Addresses
Primary practice location
15015 Northern Blvd
Flushing, NY 11354-3885
Mailing address
55 Bergen Blvd Apt 3B
Palisades Park, NJ 07650-1946
Phone (201) 561-6969
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 |
|---|---|---|---|
| 064178 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthy Heights Pharmacy Inc | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Retail Pharmacy
- New York, NY
- NPI 1164939195
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534118400000",
"number": "1366921199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 BERGEN BLVD APT 3B",
"city": "PALISADES PARK",
"state": "NJ",
"postal_code": "076501946",
"telephone_number": "201-561-6969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15015 NORTHERN BLVD",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113543885",
"telephone_number": "718-888-0851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAK",
"first_name": "SOO",
"middle_name": "KYONG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-13",
"last_updated": "2018-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "064178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.