Active NPI
Chanmyung Park, RPH
- Pharmacist
- New York, NY
National Provider Identifier
1619137619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 029951
- Practice address
- 4043 Broadway
New York, NY 10032-1516 - Phone
- (212) 795-1240
- Fax
- (212) 795-9167
- NPI assigned
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 029951 | NY | Primary |
Addresses
Primary practice location
4043 Broadway
New York, NY 10032-1516
Mailing address
4043 Broadway
New York, NY 10032-1516
Phone (212) 795-1240
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029951 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JJ Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1619137619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4043 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100321516",
"telephone_number": "212-795-1240",
"fax_number": "212-795-9167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4043 BROADWAY",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100321516",
"telephone_number": "212-795-1240",
"fax_number": "212-795-9167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "CHANMYUNG",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-12",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "029951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.