Jesse K. Park MD SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036-080235 Issued in IL

Legal business name

JESSE K. PARK MD SC

Practice address

100 Tower Dr
Suite 105
Burr Ridge, IL 60527-5777

Phone

(630) 325-8681

Fax

(630) 325-3936

NPI assigned

Nov 28, 2007

Last updated

Feb 28, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Kitai Park, MDNPI 1215042072

Title

Medical Doctor

Phone

(630) 325-8681

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jesse K Park, MD

  • Internal Medicine Physician
  • Burr Ridge, IL
  • NPI 1215042072
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362009600000",
    "number": "1942482278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TOWER DR",
            "address_2": "SUITE 105",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275777",
            "telephone_number": "630-325-8681",
            "fax_number": "630-325-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TOWER DR",
            "address_2": "SUITE 105",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275777",
            "telephone_number": "630-325-8681",
            "fax_number": "630-325-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSE K. PARK MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2013-02-28",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "KITAI",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "630-325-8681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036-080235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Joseph Jankowski, L.C.S.W.
• Laura Jaramillo, M.S., LCPC
• Brianna Jasien, LPC
• Lisa Marie Jaworski, MSN, APRN, PMHNP-BC
• Hye R Jeon, MD
• Kristin Lauren Jeziorny, FNP-C
• Jme Medical Services
• Marjorie C Johnson, OTR/L
• Michael Anthony Johnson, PHARMD
• Tarrah Johnson

• Primary Care Clinic/Center in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.