DR. JOHN MOONKEUN PARK (NPI# 1023394665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023394665 |
| Entity Type | Individual |
| Full Name | DR. JOHN MOONKEUN PARK |
| Credential | MD |
| Practice Address |
515 N 162nd Ave Ste. 300 Omaha NE 68118-2539 |
| Mailing Address |
Po Box 3755 Omaha NE 68103-0755 |
| Practice Telephone | 4023936624 |
| Practice Fax Number | 4023936635 |
| Mailing Telephone | 4023542100 |
| Mailing Fax Number | 4023542155 |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2015-02-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 35.095909 | OH | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
40563 | IA | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
26509 | NE | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
35.095909 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10025724800 | 05 | |
| NE | 10026135100 | 05 | |
| NE | 10026454700 | 05 | |
| IA | 1023394665 | 05 | |
| NE | 47068731713 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558718437 | John Park | Student in an Organized Health Care Education/Training Program | 8829 Hawthorne Ct, Ellicott City, MD 21043-3317 | 2016-05-19 |
| 1093134488 | John J. Park | Dentist | 5805 Silver Hill Rd Ste G, District Heights, MD 20747-1171 | 2014-04-14 |
| 1811265697 | John Park | Chiropractor | 2600 Walnut Ave Ste F, Tustin, CA 92780-7032 | 2011-12-07 |
| 1467759324 | John Park | Chiropractor | 256 N Sam Houston Pkwy E, Houston, TX 77060-2008 | 2011-02-11 |
| 1215168109 | John Ho Park | Radiology | 3901 Rainbow Blvd # Ms 4033, University of Kansas Medical Center, Kansas City, KS 66103-2937 | 2009-07-27 |
| 1063605988 | John Park | Case Manager/Care Coordinator | 600 Union Ave Apt B, Santa Maria, CA 93455-5327 | 2007-08-23 |
| 1144320292 | John Wonil Park | Anesthesiology | 7811 Courtney Manor Ln, Katy, TX 77494-6575 | 2006-09-25 |
| 1972538221 | John Park | Acupuncturist | 3815 1/2 Ocean View Blvd, Montrose, CA 91020-2125 | 2006-07-12 |
| 1205862075 | John Johghyun Park | Anesthesiology | 310 Egg Harbor Rd, Sewell, NJ 08080-1854 | 2006-06-24 |
| 1730181454 | John J Park | Dentist | 1079 Chambers St, Eugene, OR 97402-3706 | 2005-08-12 |
| Street Address |
515 N 162ND AVE STE. 300 |
| City | OMAHA |
| State | NE |
| Zip Code | 68118-2539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215911813 | Scott P. Wattenhofer | Surgery | 515 N 162nd Ave, Suite 300, Omaha, NE 68118-2539 | 2005-12-06 |
| 1013290477 | Physicianas Clinic, Inc. | Durable Medical Equipment & Medical Supplies | 515 N 162nd Ave, Ste. 300, Omaha, NE 68118-2539 | 2011-09-22 |
| 1578758256 | Janis Kay Cole | Nurse Practitioner | 515 N 162nd Ave, Suite # 301, Omaha, NE 68118-2539 | 2007-09-06 |
| 1043370794 | Kathryn Jane Brand | Nurse Practitioner | 515 N 162nd Ave, Suite # 301, Omaha, NE 68118-2539 | 2006-12-11 |
| 1578514725 | Bridget M Wieczorek | Advanced Practice Midwife | 515 N 162nd Ave, Suite 102, Omaha, NE 68118-2539 | 2006-05-12 |
| 1972588119 | Eugene A. Waltke | Surgery | 515 N 162nd Ave, Suite 300, Omaha, NE 68118-2539 | 2005-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932644127 | Renal Care Group of The Midwest, Inc. | Clinic/Center | 15801 West Dodge Road, Omaha, NE 68118 | 2016-12-27 |
| 1982091583 | Andrew Siref | Student in an Organized Health Care Education/Training Program | 16622 Howard Cir, Omaha, NE 68118 | 2015-04-21 |
| 1942628839 | Deirdre Anne Stolmeier | Dermatology | 515 N 162nd Ave Ste 302, Omaha, NE 68118 | 2014-03-28 |
| 1457625782 | James Clark | Pharmacist | 16130 Parker St, Omaha, NE 68118 | 2012-03-05 |
| 1619102613 | Children's West Village Pointe - Diagnostic Services | Spec/Tech, Pathology | 110 North 175 Street, Children's West Village Pointe - Diagnostic Services, Omaha, NE 68118 | 2009-05-19 |
| 1033359732 | Children's Hospital | Pediatrics | 110 North 175 Street, Suite 1000, Children's Hospital - Urgent Care - West Village Pointe, Omaha, NE 68118 | 2009-02-20 |
| 1285802538 | Becker Chiropractic LLC | Chiropractor | 17785 Mason St, Suite 101, Omaha, NE 68118 | 2008-02-20 |
| 1598940611 | Dane Patrick Becker | Chiropractor | 17785 Mason St., Suite 101, Omaha, NE 68118 | 2008-01-08 |
| 1700951779 | Karoline S Anderson | Pediatrics | 16811 Burke Street, Ste 101, Omaha, NE 68118 | 2006-11-22 |
| 1154435691 | Scott M Debates | Dermatology | 515 N 162nd Avennue, Ste. 302, Omaha, NE 68118 | 2006-08-19 |
| Find all providers in zip 68118 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346479706 | Anjan Talukdar | Surgery | 515 N 162nd Ave Ste 300, Omaha, NE 68118-2540 | 2009-07-07 |
| 1235325614 | Tammy Kauzlarich Ramos | Surgery | 1301 South 75th Street, Suite 230, Omaha, NE 68124 | 2007-09-19 |
| 1336254143 | Richard J. Feldhaus | Surgery | 7710 Mercy Rd Ste 420, Omaha, NE 68124-2346 | 2006-08-20 |
| 1205940186 | Marcus W. Balters | Surgery | 601 N 30th St # 3700, Omaha, NE 68131-2137 | 2006-08-18 |
| 1922020999 | Heartland Vein and Vascular Institute, P.C. | Surgery | 12702 Westport Pkwy, #101, Omaha, NE 68138-4012 | 2006-07-25 |
| 1215911813 | Scott P. Wattenhofer | Surgery | 515 N 162nd Ave, Suite 300, Omaha, NE 68118-2539 | 2005-12-06 |
| 1568816965 | Serenagroup Professional Services, P.C. | Surgery | 7710 Mercy Rd, Medical Building One Suite 130, Omaha, NE 68124-2372 | 2016-04-21 |
| 1558742486 | Jason Rhede Cook | Surgery | Emile @ 42nd St, Omaha, NE 68198-0001 | 2015-06-16 |
| 1831329689 | Jonathan Robert Thompson | Surgery | Emile @ 42nd St, Omaha, NE 68198-0001 | 2009-07-14 |
| 1952554214 | Jason Neal Mactaggart | Surgery | 988102 Nebraska Medical Ctr, Omaha, NE 68198-8102 | 2008-10-30 |
| Find all providers in OMAHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.