NPIMap

Individual provider Active NPI

Su Yong Pak, M.D.

  • Internal Medicine Physician
  • Lynnwood, WA
National Provider Identifier
1437169372
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A34079 Issued in CA
Practice address
6925 216TH St SW
Lynnwood, WA 98036-7358
Phone
(800) 248-9729
NPI assigned
Aug 9, 2006
Last updated
Oct 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A34079 CA Primary

Addresses

Primary practice location

6925 216TH St SW
Lynnwood, WA 98036-7358

Mailing address

5451 La Palma Ave
Ste 14
La Palma, CA 90623-1729
Phone (503) 657-8663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050322000701 CA Practitioner - Internal MedicinePractitioner - Diagnostic Radiology 2062408602 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Diagnostic Radiology
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5451 La Palma Ave
Suite 14
La Palma, CA 90623-1729
Phone (714) 523-3212

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34079CAMDGeneral Practice Dentistry
A34079CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
National Pain Association, Inc CurrentSince Jul 1, 2011 Accepting new patients
Beach Adhc, Inc. CurrentSince Aug 18, 2024 Accepting new patients
Su Yong Pak,M.D. Inc CurrentSince May 31, 2010 Accepting new patients
Mobile Ultrasound Imaging Services, Inc CurrentSince Sep 1, 2017 Accepting new patients
Symphony Diagnostic Services No 1 LLC Past Accepting new patients

Locations

4560 Beach Blvd
Buena Park, CA 90621
Phone (714) 335-6074

5451 La Palma Ave
Ste 14
La Palma, CA 90623
Phone (714) 523-3212

Interoperability endpoints

  • Direct secure messaging: suyong.pak@233273727582212.direct.elationemr.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Livingstone Home Health Services Inc.Buena Park, CA, CCN 057422 Home health agency Contracted Managing Employee Dec 1, 1999

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1437169372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5451 LA PALMA AVE",
            "address_2": "STE 14",
            "city": "LA PALMA",
            "state": "CA",
            "postal_code": "906231729",
            "telephone_number": "503-657-8663",
            "fax_number": "503-723-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6925 216TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980367358",
            "telephone_number": "800-248-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "SU YONG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A34079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

Verify at the official NPI Registry.