Jin Sup Park, MD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

E8797 Issued in TX

Practice address

8619 Pasture View LN
Houston, TX 77024-7039

Phone

(713) 686-0274

Fax

(713) 686-0274

NPI assigned

Jul 10, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Radcare of Texas PLLC

  • Diagnostic Radiology Physician
  • Fort Worth, TX
  • NPI 1164470845
  NPD (past)
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962436550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8619 PASTURE VIEW LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770247039",
            "telephone_number": "713-686-0274",
            "fax_number": "713-686-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8619 PASTURE VIEW LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770247039",
            "telephone_number": "713-686-0274",
            "fax_number": "713-686-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JIN",
        "middle_name": "SUP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "E8797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Park
• Hyunso Park, DMD
• Jaemin Park, M.D.
• James Vance Park II
• Jessica Park, DDS
• John Park
• Jonathon Park, DDS
• Jong Kun Park, MD
• Jonghun Park, APRN
• Joon Il Park, MD

• Vascular & Interventional Radiology Physician in Houston, TX
• Providers in Houston, TX by specialty
• Vascular & Interventional Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.