Ellen Sae Eun Park, N.P

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

95005023 Issued in CA

Practice address

6900 Lincoln Ave
Buena Park, CA 90620-4148

Phone

(714) 522-4009

NPI assigned

Oct 19, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Sae Eun Park Former 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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Healthcare Partners Affiliates Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment NPD
• Healthcare Partners Affiliates Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD
• Memorial Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1255523643
  NPD (past)

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1922559442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 LINCOLN AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204148",
            "telephone_number": "714-522-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 LINCOLN AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204148",
            "telephone_number": "714-522-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ELLEN",
        "middle_name": "SAE EUN",
        "credential": "N.P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-19",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95005023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAE EUN",
            "last_name": "PARK",
            "credential": "N.P",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pain MD Associates, Inc
• Pamela Pantiru, MSW
• Angela Park
• Caitlyn Jeein Park
• Chulhoon Park, L.AC.
• Euna Lim Park
• Eunice Park
• Eunsuk Park, L. AC
• Hwan Park, ACUPUNCTURIST
• Hyehyun J Park, LCSW

• Primary Care Nurse Practitioner in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Primary Care Nurse Practitioner in California

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