Organization Active NPI

Park Family Medicine LLC

  • Family Medicine Physician
  • Tucson, AZ
National Provider Identifier
1376488858
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PARK FAMILY MEDICINE LLC
Practice address
310 N Wilmot Rd Ste 301
Tucson, AZ 85711-2628
Phone
(520) 771-6675
Fax
(520) 771-9507
NPI assigned
Apr 21, 2026
Last updated
Apr 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Authorized official

Name
Dr. Eun Soo David Park, MDNPI 1407205743
Title
Owner
Phone
(520) 771-6675

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

310 N Wilmot Rd Ste 301
Tucson, AZ 85711-2628

Mailing address

310 N Wilmot Rd Ste 301
Tucson, AZ 85711-2628
Phone (520) 771-6675

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260622004031 AZ Part B Supplier - Clinic/Group Practice 6507339579 Receives reassigned benefits from 1 practitioner
Practice locations: Tucson, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2338189Park Family Medicine LLC310 N Wilmot Rd Ste 301, Tucson, AZ 85711Certificate of waiverFeb 5, 2028

National Provider Directory

National Provider Directory

Locations

310 N Wilmot Rd
Ste 301
Tucson, AZ 85711
Phone (520) 296-9059

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1376488858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N WILMOT RD STE 301",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112628",
            "telephone_number": "520-771-6675",
            "fax_number": "520-771-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N WILMOT RD STE 301",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112628",
            "telephone_number": "520-771-6675",
            "fax_number": "520-771-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "EUN SOO",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-771-6675",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.