Active NPI
Kwangwon Park, MD, PHD
- Orthopaedic Surgery Physician
- Omaha, NE
National Provider Identifier
1801423157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 35792
- Practice address
- 111 N 84TH St
Omaha, NE 68114-4101 - Phone
- (402) 955-6329
- Fax
- (202) 877-8959
- NPI assigned
- Mar 26, 2020
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 35792 | NE | Primary |
Addresses
Primary practice location
111 N 84TH St
Omaha, NE 68114-4101
Mailing address
111 N 84TH St
Omaha, NE 68114-4101
Phone (402) 955-6329
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
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35792 | NE | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital & Medical Center | Past | Accepting new patients | |
| Nebraska Pediatric Practice, Inc | Single Specialty | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Children's Hospital
- Omaha, NE
- NPI 1346297843
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762732800000",
"number": "1801423157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 N 84TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144101",
"telephone_number": "402-955-6329",
"fax_number": "402-955-6529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N 84TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144101",
"telephone_number": "402-955-6329",
"fax_number": "202-877-8959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KWANGWON",
"name_prefix": "Dr.",
"credential": "MD, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-26",
"last_updated": "2025-11-10",
"certification_date": "2025-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": "NE",
"license": "35792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.