Baly Juan Seo Park

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

13568 Issued in CT

Practice address

263 Farmington Ave
Farmington, CT 06030-0001

Phone

(679) 860-2000

NPI assigned

Aug 22, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1790403137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 TALCOTT RIDGE RD UNIT G",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060323513",
            "telephone_number": "959-225-0288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "679-860-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEO PARK",
        "first_name": "BALY",
        "middle_name": "JUAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CT",
            "license": "13568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Selig
• Sharon Lynn Selinga-Rewenko, DMD
• Chindhuri Selvadurai, M.D.
• Meng Francois Seng, DMD
• Elizabeth Sennett Crocco, LCSW
• Dianne Seo, D.O.
• Bruce Seplowitz, O.D.
• Nicole Marika Sequeira, MBBS
• Nikolaos Serifis, MD
• Sudiksha Sethia, MD

• Student in an Organized Health Care Education/Training Program in Farmington, CT
• Providers in Farmington, CT by specialty
• Student in an Organized Health Care Education/Training Program in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.