NPIMap

Individual provider Active NPI

Jung K Park, M.D.

  • Diagnostic Radiology Physician
  • Phoenix, AZ
National Provider Identifier
1700834777
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
26466 Issued in AZ
Practice address
11209 N Tatum Blvd
Suite #110
Phoenix, AZ 85028-3091
Phone
(602) 248-8002
Fax
(602) 248-8399
NPI assigned
May 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 26466 AZ Primary
Vascular & Interventional Radiology Physician 2085R0204X F91378 AZ

Addresses

Primary practice location

11209 N Tatum Blvd
Suite #110
Phoenix, AZ 85028-3091

Mailing address

PO Box 14687
Scottsdale, AZ 85267-4687
Phone (480) 991-8100

Other identifiers 3

IdentifierTypeStateIssuer
1Z7049OtherAZHEALTHNET
AZ0324990OtherAZBCBS
431726OtherAZAHCCCS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040614000737 AZ Practitioner - Diagnostic Radiology 6507848173 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Valley Radiology Associates PLLCGroup PAC ID 2062916083, 32 clinicians

Practice addresses (Care Compare)

Scottsdale, AZ 85251
Phone (480) 728-3000

6091 Westridge Rd
Heber City, UT 84032-5601
Phone (918) 392-1702

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26466AZMDDiagnostic Radiology Physician
F91378AZMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Radiology Associates PLLC Diagnostic Radiology CurrentSince Sep 1, 2025 Accepting new patients
Analytic Medical Imaging, LTD Diagnostic Radiology Past Accepting new patients
Arizona Diagnostic & Surgical Center, Inc Past Accepting new patients
Phoenix Diagnostic Imaging, Inc Past Accepting new patients

Locations

1955 W Frye Rd
Chandler, AZ 85224
Phone (480) 507-2961

3555 S Val Vista Dr
Gilbert, AZ 85297
Phone (480) 434-4356

20750 N John Wayne Pkwy
Maricopa, AZ 85139
Phone (520) 233-2468

Organizations & group practices 4

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1700834777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14687",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852674687",
            "telephone_number": "480-991-8100",
            "fax_number": "480-922-1028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11209 N TATUM BLVD",
            "address_2": "SUITE #110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283091",
            "telephone_number": "602-248-8002",
            "fax_number": "602-248-8399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JUNG",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "26466",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "AZ",
            "license": "F91378",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z7049",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0324990",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "431726",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.