Kyle K Park, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35037628 Issued in OH

Practice address

107 Houpt Drive
Upper Sandusky, OH 43351-9201

Phone

(419) 294-5757

Fax

(419) 209-0623

NPI assigned

Sep 14, 2007

Last updated

Apr 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Kyu Park MD Inc

  • Family Medicine Physician
  • Upper Sandusky, OH
  • NPI 1902888712
  Authorized official Same address or phone
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1609062488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 HOUPT DRIVE",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433519201",
            "telephone_number": "419-294-5757",
            "fax_number": "419-209-0623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 HOUPT DRIVE",
            "city": "UPPER SANDUSKY",
            "state": "OH",
            "postal_code": "433519201",
            "telephone_number": "419-294-5757",
            "fax_number": "419-209-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYLE",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-14",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35037628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0408811",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Orians Family Chiropractic, Inc.
• Isaac Joseph Orians, D.C.
• Orthopaedic Institute of Ohio, Inc.
• Kwabena Osei, MD
• Darlene Paaaina
• Reece Paul
• Troy Perkins
• Amy A Phillips, PAC
• Kayla Pierson, RN
• Tiffany R. Pottkotter, CNP

• Family Medicine Physician in Upper Sandusky, OH
• Providers in Upper Sandusky, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.