Active NPI
Pup-Shin Park, RPH.
- Pharmacist
- Federal Way, WA
National Provider Identifier
1407103310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00013062
- Practice address
- 31260 Pacific Hwy S Ste 10
Federal Way, WA 98003-5448 - Phone
- (253) 839-1399
- Fax
- (253) 839-1477
- NPI assigned
- Aug 9, 2012
- Last updated
- Aug 9, 2012
- Sex
- Male
- 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 | PH00013062 | WA | Primary |
Addresses
Primary practice location
31260 Pacific Hwy S Ste 10
Federal Way, WA 98003-5448
Mailing address
1700 166TH CT SE
Mill Creek, WA 98012-6076
Phone (206) 355-1903
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00013062 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Welu Healthcare Inc | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344470400000",
"number": "1407103310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 166TH CT SE",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980126076",
"telephone_number": "206-355-1903",
"fax_number": "253-839-1477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31260 PACIFIC HWY S STE 10",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980035448",
"telephone_number": "253-839-1399",
"fax_number": "253-839-1477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "PUP-SHIN",
"credential": "RPH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-09",
"last_updated": "2012-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00013062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Federal Way, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.