NPIMap

Individual provider Active NPI

Gyuhyun Park, DPT

  • Physical Therapist
  • Winemucca, NV
National Provider Identifier
1417420639
Registry record updated Jan 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3910 Issued in NV
Practice address
325 Hanson Stereet
Winemucca, NV 89445-3607
NPI assigned
Jan 10, 2019
Last updated
Jan 10, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 3910 NV Primary

Addresses

Primary practice location

325 Hanson Stereet
Winemucca, NV 89445-3607

Mailing address

325 Hanson St
Winnemucca, NV 89445-3607
Phone (775) 625-2222

Other practice location 1

325 Hanson St
Winnemucca, NV 89445-3607

Other practice location 2

325 Hanson St
Winnemucca, NV 89445-3607

Other practice location 3

325 Hanson St
Winnemucca, NV 89445-3607

Other practice location 4

325 Hanson St
Winnemucca, NV 89445-3607

Other practice location 5

325 Hanson St
Winnemucca, NV 89445-3607

Other practice location 6

325 Hanson St
Winnemucca, NV 89445-3607

Other identifiers 1

IdentifierTypeStateIssuer
3910OtherNVPHYSICAL THERAPY LICENSE

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

LicenseStateTypeSpecialty
3910NVMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1417420639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 HANSON ST",
            "city": "WINNEMUCCA",
            "state": "NV",
            "postal_code": "894453607",
            "telephone_number": "775-625-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 HANSON STEREET",
            "city": "WINEMUCCA",
            "state": "NV",
            "postal_code": "894453607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 Hanson St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453607",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Hanson St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453607",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Hanson St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453607",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Hanson St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453607",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Hanson St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453607",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Hanson St",
            "address_purpose": "LOCATION",
            "city": "Winnemucca",
            "state": "NV",
            "postal_code": "894453607",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "GYUHYUN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "3910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "3910",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.