Kyung I. Park, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

C50980 Issued in CA

Practice address

12362 Beach Blvd
#10
Stanton, CA 90680-3935

Phone

(714) 743-5733

Fax

(714) 622-4943

NPI assigned

Aug 8, 2006

Sex

Male

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

• Dr. Kyung Il 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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Stanton, CA
  • NPI 1952662686

  Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

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.

• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Stanton, CA
  • NPI 1952662686
  Medicare reassignment NPD Authorized official
• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Fullerton, CA
  • NPI 1881210318
  NPD Authorized official

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682812800000",
    "number": "1942210570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD",
            "address_2": "#10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803935",
            "telephone_number": "714-248-9500",
            "fax_number": "714-622-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD",
            "address_2": "#10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803935",
            "telephone_number": "714-743-5733",
            "fax_number": "714-622-4943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYUNG",
        "middle_name": "I.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2023-04-30",
        "certification_date": "2023-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "C50980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYUNG",
            "last_name": "PARK",
            "middle_name": "IL",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Paramount Home Care, Inc.
• Ami Tapan Parikh
• Jeong Ae Park, LAC, PHD
• Jessica Park
• Justin Park
• Diana Parmar, MFT
• Violina Iulieta Peapea
• Anthony Peck II
• Bridget Nicole Pedersen
• Karina Pedraza

• Neurology Physician in Stanton, CA
• Providers in Stanton, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.