Active NPI
Chan Jin Park, L.AC
- Acupuncturist
- Bayside, NY
National Provider Identifier
1508404492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 5471
- Practice address
- 21537 48TH Ave Apt 2B
Bayside, NY 11364-1359 - Phone
- (347) 549-2275
- NPI assigned
- Dec 11, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 5471 | NY | Primary |
Addresses
Primary practice location
21537 48TH Ave Apt 2B
Bayside, NY 11364-1359
Mailing address
21537 48TH Ave Apt 2B
Bayside, NY 11364-1359
Phone (347) 549-2275
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5471 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576022400000",
"number": "1508404492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21537 48TH AVE APT 2B",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113641359",
"telephone_number": "347-549-2275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21537 48TH AVE APT 2B",
"city": "BAYSIDE",
"state": "NY",
"postal_code": "113641359",
"telephone_number": "347-549-2275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "CHAN",
"middle_name": "JIN",
"credential": "L.AC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-11",
"last_updated": "2019-12-11",
"certification_date": "2019-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NY",
"license": "5471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.