Active NPI
Kie Jung Park, MD
- Psychiatry Physician
- Kingston, PA
National Provider Identifier
1477596088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD033477L
- Practice address
- 562 Wyoming Ave
Kingston, PA 18704 - Phone
- (570) 552-3900
- Fax
- (570) 552-3907
- NPI assigned
- Jun 13, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Psychiatry Physician | 2084P0802X | MD033477L | PA | |
| Geriatric Psychiatry Physician | 2084P0805X | MD033477L | PA | |
| Psychiatry Physician | 2084P0800X | MD033477L | PA | Primary |
Addresses
Primary practice location
562 Wyoming Ave
Kingston, PA 18704
Mailing address
6 Revere Rd
Mountain Top, PA 18707
Phone (570) 552-3900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007338991 | Medicaid | PA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luzerne Wyoming County Mental Health Center #1 | Past | Accepting new patients | |
| Luzerne Wyoming County Mental Health Center #1 | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Wilkes Barre, PA
- NPI 1487774824
-
- Psychiatric Hospital
- Kingston, PA
- NPI 1861425159
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254441600000",
"number": "1477596088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 REVERE RD",
"city": "MOUNTAIN TOP",
"state": "PA",
"postal_code": "18707",
"telephone_number": "570-552-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "562 WYOMING AVE",
"city": "KINGSTON",
"state": "PA",
"postal_code": "18704",
"telephone_number": "570-552-3900",
"fax_number": "570-552-3907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KIE",
"middle_name": "JUNG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2009-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0802X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Psychiatry",
"state": "PA",
"license": "MD033477L",
"primary": false
},
{
"code": "2084P0805X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Geriatric Psychiatry",
"state": "PA",
"license": "MD033477L",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD033477L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007338991",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingston, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.