Active NPI
Steven Yeong-Soo Park, DPT
- Physical Therapist
- Beaverton, OR
National Provider Identifier
1629447925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 51409
- Practice address
- 735 SW 158TH Ave
Suite 160
Beaverton, OR 97006-4952 - Phone
- (503) 597-0035
- Fax
- (503) 726-5490
- NPI assigned
- Sep 17, 2015
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 51409 | OR | Primary |
Addresses
Primary practice location
735 SW 158TH Ave
Suite 160
Beaverton, OR 97006-4952
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51409 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469059200000",
"number": "1629447925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223",
"fax_number": "630-759-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "735 SW 158TH AVE",
"address_2": "SUITE 160",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970064952",
"telephone_number": "503-597-0035",
"fax_number": "503-726-5490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "STEVEN",
"middle_name": "YEONG-SOO",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-17",
"last_updated": "2016-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "51409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.