NPIMap

Individual provider Active NPI

Yoojin Park, M.D.

  • Family Medicine Physician
  • Puyallup, WA
National Provider Identifier
1417212812
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60539959 Issued in WA
Practice address
15214 Canyon Rd E Ste 120
Puyallup, WA 98375-7457
Phone
(253) 539-4200
Fax
(253) 944-6986
NPI assigned
Jul 11, 2012
Last updated
Dec 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60539959 WA Primary

Addresses

Primary practice location

15214 Canyon Rd E Ste 120
Puyallup, WA 98375-7457

Mailing address

15214 Canyon Rd E Ste 120
Puyallup, WA 98375-7457
Phone (253) 539-4200

Other identifiers 1

IdentifierTypeStateIssuer
2044629MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmeleney468265@fhsce.catholichealth.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150724012354 WA Practitioner - Family Practice 5597078154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

15214 Canyon Rd E
Suite 120
Puyallup, WA 98375-7472
Phone (253) 539-6023

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Feb 27, 2019 Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Feb 27, 2019 Accepting new patients

Locations

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

15214 Canyon Rd E
Ste 120
Puyallup, WA 98375
Phone (253) 539-4200

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: kmeleney468265@fhsce.catholichealth.net

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1417212812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15214 CANYON RD E STE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983757457",
            "telephone_number": "253-539-4200",
            "fax_number": "253-944-6986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15214 CANYON RD E STE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983757457",
            "telephone_number": "253-539-4200",
            "fax_number": "253-944-6986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "YOOJIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60539959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2044629",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmeleney468265@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "15214 Canyon Rd E Ste 120",
            "city": "Puyallup",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983757457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.