Mina Park, AGNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95002208 Issued in CA

Practice address

8650 Belford Ave Apt 225
Los Angeles, CA 90045-4553

Phone

(818) 987-5088

NPI assigned

Dec 18, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mina.park.1@30710.direct.athenahealth.com

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.

• Albion Medical Partners of California West P C

  dba CareMore Health Medical Partners West, PC

  • Internal Medicine Physician
  • Cerritos, CA
  • NPI 1073110607
  Medicare reassignment NPD

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450396800000",
    "number": "1417312406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8650 BELFORD AVE APT 225",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454553",
            "telephone_number": "818-987-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8650 BELFORD AVE APT 225",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454553",
            "telephone_number": "818-987-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MINA",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-18",
        "last_updated": "2015-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95002208",
            "primary": true
        },
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "CA",
            "license": "95002208",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael David Park, DDS
• Michelle Eunmin Park
• Mihee Park, M.D.
• Min Seuk Park, M.D.
• Min Su Park
• Minju Park
• Naomi Park
• Nicholas Park
• No Hee Park, PH.D.,D.M.D
• On Jung Park, LA.C

• Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.