Active NPI
Hyun Dong Park, MD
- Pediatrics Physician
- Flushing, NY
National Provider Identifier
1962447706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 113679
- Practice address
- 3511 Farrington St
Flushing, NY 11354-2826 - Phone
- (718) 886-7014
- Fax
- (516) 437-4167
- NPI assigned
- Jun 17, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 113679 | NY | Primary |
Addresses
Primary practice location
3511 Farrington St
Flushing, NY 11354-2826
Mailing address
PO Box 27842
New York, NY 10087-7842
Phone (718) 670-1651
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02533815 | Medicaid | NY |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113679 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207094400000",
"number": "1962447706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27842",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100877842",
"telephone_number": "718-670-1651",
"fax_number": "516-437-4167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3511 FARRINGTON ST",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113542826",
"telephone_number": "718-886-7014",
"fax_number": "516-437-4167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "HYUN",
"middle_name": "DONG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2008-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "113679",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02533815",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.