Active NPI
Kyuhun Park
- Special Hospital
- Elmwood Park, IL
National Provider Identifier
1679939417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Special Hospital
- License
- 090.005328
- Practice address
- 2540 N Harlem Ave
Elmwood Park, IL 60707-2046 - Phone
- (708) 452-7275
- Fax
- (708) 452-7295
- NPI assigned
- Jan 9, 2016
- 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 |
|---|---|---|---|---|
| Special Hospital | 284300000X | 090.005328 | IL | Primary |
Addresses
Primary practice location
2540 N Harlem Ave
Elmwood Park, IL 60707-2046
Mailing address
2540 N Harlem Ave
Elmwood Park, IL 60707-2046
Phone (708) 452-7275
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 |
|---|---|---|---|
| 090.005328 | IL | MD | Special Hospital |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452297600000",
"number": "1679939417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2540 N HARLEM AVE",
"city": "ELMWOOD PARK",
"state": "IL",
"postal_code": "607072046",
"telephone_number": "708-452-7275",
"fax_number": "708-452-7295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2540 N HARLEM AVE",
"city": "ELMWOOD PARK",
"state": "IL",
"postal_code": "607072046",
"telephone_number": "708-452-7275",
"fax_number": "708-452-7295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KYUHUN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-01-09",
"last_updated": "2016-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "284300000X",
"taxonomy_group": "",
"desc": "Special Hospital",
"state": "IL",
"license": "090.005328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmwood Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.