Ro Jong Park, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

C51913 Issued in CA

Practice address

7825 Engineer Rd
#101
San Diego, CA 92111-1929

Phone

(858) 277-7111

Fax

(858) 277-7667

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Practice

Education

Other, 1963

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Woori Medical Group, Professional CorpGroup PAC ID 5799831848, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Woori Medical Group Professional Corp

  • General Practice Physician
  • San Diego, CA
  • NPI 1275764706
  Medicare reassignment Care Compare group NPD Authorized official
• Three Rivers Health Authority

  • Rehabilitation Hospital Unit
  • Three Rivers, MI
  • NPI 1245347343
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195603200000",
    "number": "1699799593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7825 ENGINEER RD",
            "address_2": "#101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921111929",
            "telephone_number": "858-277-7111",
            "fax_number": "858-277-7667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7825 ENGINEER RD",
            "address_2": "#101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921111929",
            "telephone_number": "858-277-7111",
            "fax_number": "858-277-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "RO",
        "middle_name": "JONG",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "32106",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C51913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104171946",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Sinae Park
• Paul Park, PHARMD
• Paula Park, PHARMD, PHD
• Peter Joonsun Park, M.D.
• Renee Yoosun Park, DDS
• Samuel Park, M.D.
• Sara Heejung Park, MD
• Seo Hyun Park
• Sharon Park
• Sharon Heera Park

• Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.