Active NPI
Joon Park, M.D.
- Pediatric Cardiology Physician
- Lubbock, TX
National Provider Identifier
1902887771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- E9904
- Practice address
- 3502 9TH St
Suite 290
Lubbock, TX 79415-3300 - Phone
- (806) 743-1540
- Fax
- (806) 743-3908
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | E9904 | TX | Primary |
Addresses
Primary practice location
3502 9TH St
Suite 290
Lubbock, TX 79415-3300
Mailing address
PO Box 5865
Lubbock, TX 79408-5865
Phone (806) 743-2898
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44268 | Other | NM | PRESBYTERIAN COMMERCIAL |
| 44268 | Medicaid | NM | |
| 85E551 | Other | TX | BC/BS |
| A078 | Other | NM | TRIWEST |
| V3884 | Medicaid | NM | |
| 80896Z | Other | TX | HMO BLUE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1902887771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5865",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794085865",
"telephone_number": "806-743-2898",
"fax_number": "806-743-2787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3502 9TH ST",
"address_2": "SUITE 290",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794153300",
"telephone_number": "806-743-1540",
"fax_number": "806-743-3908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JOON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "TX",
"license": "E9904",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN COMMERCIAL",
"identifier": "44268",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44268",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "85E551",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIWEST",
"identifier": "A078",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "V3884",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMO BLUE",
"identifier": "80896Z",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.