NPIMap

Individual provider Active NPI

Hyo Kwon Park, D.O.

  • Family Medicine Physician
  • Dinwiddie, VA
National Provider Identifier
1730170770
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102202692 Issued in VA
Practice address
13855 Courthouse Rd
Dinwiddie, VA 23841-2254
Phone
(804) 469-3731
Fax
(804) 469-5307
NPI assigned
Oct 31, 2005
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0102202692 VA Primary

Addresses

Primary practice location

13855 Courthouse Rd
Dinwiddie, VA 23841-2254

Mailing address

P.O. Box 70
1508 K-V Road
Victoria, VA 23974
Phone (434) 696-2165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20101115000893 VA Practitioner - Family Practice 7618981622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13855 Courthouse Rd
Dinwiddie, VA 23841-2254
Phone (804) 469-3731

1418 6TH St
Victoria, VA 23974-0070
Phone (434) 696-4180

1508 K V Rd
Victoria, VA 23974-2624
Phone (434) 696-2165

8920 Otterburn Rd
Amelia Court House, VA 23002-4854
Phone (434) 696-2165

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Dominion Health System, Inc. Current Accepting new patients
Southern Dominion Health System, Inc. CurrentSince Aug 16, 2010 Accepting new patients

Locations

8920 Otterburn Rd
Amelia Ct Hse, VA 23002
Phone (804) 288-8838

13855 Courthouse Rd
Dinwiddie, VA 23841
Phone (804) 469-3731

510 N Main St
Emporia, VA 23847
Phone (434) 634-7723

1508 K V Rd
Victoria, VA 23974
Phone (434) 696-2165

Interoperability endpoints

  • Direct secure messaging: hyo.park@sdhs.directbygreenway.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1730170770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 70",
            "address_2": "1508 K-V ROAD",
            "city": "VICTORIA",
            "state": "VA",
            "postal_code": "23974",
            "telephone_number": "434-696-2165",
            "fax_number": "434-696-1557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13855 COURTHOUSE RD",
            "city": "DINWIDDIE",
            "state": "VA",
            "postal_code": "238412254",
            "telephone_number": "804-469-3731",
            "fax_number": "804-469-5307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "HYO",
        "middle_name": "KWON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102202692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dinwiddie, VA

Sources for this page

Verify at the official NPI Registry.