DR. KYE SOO PARK (NPI# 1043359037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043359037 |
| Entity Type | Individual |
| Full Name | DR. KYE SOO PARK |
| Credential | MD |
| Practice Address |
700 Ne 87th Ave Vancouver WA 98664-1913 |
| Practice Telephone | 3603973370 |
| Practice Fax Number | 3606041749 |
| Mailing Telephone | 3603973370 |
| Mailing Fax Number | 3606041749 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2010-09-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 2004-0437 | NM | Allopathic & Osteopathic Physicians |
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
MD60145123 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L & I | 0262973 | 01 |
| WA | 1043359037 | 05 |
| Street Address |
700 NE 87TH AVE |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664-1913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447255112 | Lewis Mark Steinberg | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2005-06-17 |
| 1598398141 | Blakely Garrity | Physician Assistant | 700 Ne 87th Ave, Vancouver, WA 98664-4896 | 2020-02-21 |
| 1851958797 | Rosa Pham | Nurse Practitioner | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2019-05-28 |
| 1902368319 | Alexandria Eunsong Yeo | Nurse Practitioner | 700 Ne 87th Ave, Vancouver, WA 98664-4896 | 2019-04-03 |
| 1568961100 | Jill Renee Bradley | Nurse Practitioner | 700 Ne 87th Ave, Vancouver, WA 98664-4896 | 2018-02-09 |
| 1245757939 | Matthew Elamparo | Pharmacist | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2017-08-24 |
| 1174051023 | Fred Meyer Stores Inc | Durable Medical Equipment & Medical Supplies | 700 Ne 87th Ave, Suite 180, Vancouver, WA 98664-1913 | 2017-05-23 |
| 1952833741 | Jeanne Lothrop Gurney | Nurse Practitioner | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2017-03-30 |
| 1730639626 | Cameron M Schmidt | Physician Assistant | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2016-10-04 |
| 1164971610 | David C Turro Jr. | Physician Assistant | 700 Ne 87th Ave, Suite 140, Vancouver, WA 98664-1913 | 2016-09-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249938 | Angelica Maria Parle-fresquez | Speech-Language Pathologist | Early Childhood Assessment Center - Lieser School, 301 S. Lieser Rd, Vancouver, WA 98664 | 2020-09-10 |
| 1467923441 | Elizabeth Steen | Counselor | 230 E. State St., Mossyrock, WA 98664 | 2018-12-17 |
| 1497241657 | Chelsey Nicole Parker | Peer Specialist | 9815 Ne 3rd St, Vancouver, WA 98664 | 2018-07-10 |
| 1881145431 | Brent Homan | Occupational Therapist | 807 Se Morgan Rd., Vancouver, WA 98664 | 2016-10-19 |
| 1114474277 | Rebecca Marie Stefan | Nurse's Aide | 10025 Ne 19th St, Vancouver, WA 98664 | 2016-09-07 |
| 1528454105 | Alicia Ford | Dietitian, Registered | 700 Ne 87th Ave Ste 280, Vancouver, WA 98664 | 2015-04-10 |
| 1033504261 | Reid Roberts Bennett | Anesthesiology | 505 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2015-04-03 |
| 1235550856 | Nikolay Nikolaevich Chernukhin Jr. | Chiropractor | 221-a Ne 104th Ave, Suite 205, Vancouver, WA 98664 | 2013-12-27 |
| 1013278712 | Serena Harker | Physical Therapy Assistant | 221a Ne 104th Ave, Suite #205, Vancouver, WA 98664 | 2012-05-30 |
| 1295091080 | Rebeca C Johnson | Massage Therapist | 11015 Ne 4th Plain Suite B, Vancouver, WA 98664 | 2012-04-05 |
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| Taxonomy Code | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750433546 | Lisa Vasanth | Internal Medicine | 700 Ne 87th Ave # 330, Vancouver, WA 98664-1913 | 2007-01-18 |
| 1215035670 | Esther Hwang | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2006-09-20 |
| 1881635308 | Theresa Karplus | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2006-06-08 |
| 1992746432 | Uzma Khan | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2006-06-08 |
| 1548209653 | David Bong | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2006-06-05 |
| 1689612525 | Marcia Sparling | Internal Medicine | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437410354 | Jeonghun Moon | Internal Medicine | 4033 Talbot Rd S Ste 440, Renton, WA 98055-5767 | 2012-06-06 |
| 1356571087 | Christopher C. Wright | Internal Medicine | 105 W 8th Ave Ste 6080, Spokane, WA 99204-2313 | 2009-07-15 |
| 1508094707 | Daniel Jaeung Kim | Internal Medicine | 11311 Bridgeport Way Sw Ste 100, Lakewood, WA 98499-3096 | 2009-06-25 |
| 1962623959 | Wayne J Wallis | Internal Medicine | 2339 Federal Ave E, Seattle, WA 98102-4031 | 2007-05-01 |
| 1639399546 | Robert Lee Johnson | Internal Medicine | 1735 W Sunn Fjord Ln, Apartment I-107, Bremerton, WA 98312-5327 | 2007-04-26 |
| 1093933491 | Western Washington Medical Group, Inc Ps | Internal Medicine | 1330 Rockefeller Ave Ste 330, Everett, WA 98201 | 2007-04-23 |
| 1225196215 | John Flint Dickson | Internal Medicine | 714 Bellevue Ave East, #401, Seatlle, WA 98102-5990 | 2006-12-04 |
| 1659445260 | Janice Gupta | Internal Medicine | 515 Minor Avneue, Seattle, WA 98104 | 2006-11-17 |
| 1336218171 | Philip J Mease | Internal Medicine | 1101 Madison St Ste 1000, Seattle, WA 98104-3556 | 2006-11-07 |
| 1982781225 | Immune Disease Treatment Services Pllc | Internal Medicine | 14100 Se 36th St Ste 105, Bellevue, WA 98006-1657 | 2006-11-01 |
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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.