Taikeun Park, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C51444 Issued in CA

Practice address

251 Landis Avenue
Chula Vista, CA 91910-9578

Phone

(619) 515-2500

Fax

(619) 934-9578

NPI assigned

Dec 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ken Park Other name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment NPD
• Family Health Centers of San Diego Inc

  dba Rice Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1083959464
  NPD
• Shin Yu, M.D., P.C.

  • Internal Medicine Physician
  • Ridgewood, NY
  • NPI 1720314594
  NPD (past)

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1831175918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13788 TORREY DEL MAR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921305629",
            "telephone_number": "858-997-5927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 LANDIS AVENUE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919109578",
            "telephone_number": "619-515-2500",
            "fax_number": "619-934-9578"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13788 Torrey Del Mar Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921305629",
            "country_code": "US",
            "telephone_number": "858-997-5927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "TAIKEUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "C51444",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C51444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEN",
            "last_name": "PARK",
            "credential": "M.D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Parizad Seraj DDS
• Park Medical Pharmacy (Medical Center Pharmacy)
• Park Medical Pharmacy (Community Medical Center Pharmacy)
• Park Medical Pharmacy, Inc (Community Medical Center Pharmacy)
• Chante D Park
• Barbara J Parker
• Chyna Parker
• Rachel Marian Parker, M.ED. PPSC
• Hannah Karen Parmentier
• Ashley Soleil Parra

• Internal Medicine Physician in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.