Bong Kwan Park, DOM

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AP 3556 Issued in FL

Practice address

14471 S Dixie Hwy
Miami, FL 33176-7924

Phone

(213) 700-0042

Fax

(786) 573-4777

NPI assigned

May 16, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455062400000",
    "number": "1508023664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14471 S. DIXIE HWY",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33176",
            "telephone_number": "213-700-0042",
            "fax_number": "786-573-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14471 S DIXIE HWY",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331767924",
            "telephone_number": "213-700-0042",
            "fax_number": "786-573-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BONG KWAN",
        "name_prefix": "Dr.",
        "credential": "DOM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-16",
        "last_updated": "2016-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "10718",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "FL",
            "license": "AP 3556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Parisi
• Park Avenue Psychotherapy LCSW PC
• Park Place Assisted Living, Inc.
• Park Plaza Supplies Corp
• Park Street Health Services, LLC
• Grant Jaeyhung Park
• Halley Park, M.D.
• James Kunwoo Park, MD
• Junghyun Park
• Kaylee Brianna Park, MD

• Acupuncturist in Miami, FL
• Providers in Miami, FL by specialty
• Acupuncturist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; 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.