JENNIFER PARK (NPI# 1245679182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245679182 |
| Entity Type | Individual |
| Full Name | JENNIFER PARK |
| Credential | M.D. |
| Practice Address |
4545 E Chandler Blvd Ste 104 Phoenix AZ 85048 |
| Mailing Address |
3030 N Central Ave Ste 1001 Phoenix AZ 85012-2716 |
| Practice Telephone | 4807284400 |
| Practice Fax Number | 4802223422 |
| Mailing Telephone | 6024064786 |
| Mailing Fax Number | 9166364358 |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-07-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 52982 | AZ | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | R74065 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | TRAINING PERMIT | R74065 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2927 N 7th Ave, Peppertree Building, Phoenix, AZ 850134102 | 6024063153 | 6024067176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033757455 | Jennifer Park | Durable Medical Equipment & Medical Supplies | 1840 Ventura Blvd, Camarillo, CA 93010-7848 | 2019-12-16 |
| 1174095210 | Jennifer Park | Counselor | 20 S 36th St Ste 201, Camp Hill, PA 17011-4355 | 2018-12-31 |
| 1538510599 | Jennifer Park | Dentist | 5750 Dow Ave Apt 241, Alexandria, VA 22304-4071 | 2016-06-30 |
| 1568880318 | Jennifer Park | Ophthalmology | 1855 W Taylor St Ste 3.138, Chicago, IL 60612 | 2014-03-30 |
| 1427392760 | Jennifer Alane Park | Social Worker | 7000 Oak Forest Ln, Bethesda, MD 20817-2124 | 2012-11-26 |
| 1063402147 | Jennifer M Park | Psychiatry & Neurology | 1355 Beverly Rd, Suite 225, Mc Lean, VA 22101-3651 | 2005-10-28 |
| 1063024552 | Jennifer Park | Pharmacist | 520 Convery Blvd, Perth Amboy, NJ 08861 | 2020-08-18 |
| 1740817642 | Jennifer Eun Kyong Park | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave # Chs27139, Los Angeles, CA 90095-3075 | 2020-03-23 |
| 1417594672 | Jennifer Park | Pharmacist | 1650 Decoto Rd, Union City, CA 94587-3544 | 2019-12-06 |
| 1083260558 | Jennifer Park | Social Worker | 323 W Mulberry St, Watseka, IL 60970-1568 | 2019-08-12 |
| Street Address |
4545 E CHANDLER BLVD STE 104 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609834647 | Curtis Reid Mewhinney | Physician Assistant | 4545 E Chandler Blvd Ste 104, Phoenix, AZ 85048 | 2006-05-01 |
| 1669768305 | Afzal Hussian Khan | Family Medicine | 4545 E Chandler Blvd Ste 104, Phoenix, AZ 85048-7647 | 2011-06-21 |
| 1982837563 | Christina Marie Zimmerman | Nurse Practitioner | 4545 E Chandler Blvd Ste 104, Phoenix, AZ 85048-7647 | 2009-08-28 |
| 1871654418 | Alice Ruth Peterson | Physician Assistant | 4545 E Chandler Blvd Ste 104, Phoenix, AZ 85048 | 2006-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164062618 | Smile Dentistry Pllc | Dentist | 1238 E. Chandler Blvd. #101, Phoenix, AZ 85048 | 2020-01-13 |
| 1558924415 | Ahwatukee Orthodontic Associates Inc | Dentist | 16611 S. 40th Street, Suite 110, Phoenix, AZ 85048 | 2019-04-17 |
| 1699299560 | Brianna Alean Kinsey | Student in an Organized Health Care Education/Training Program | 16214 S. 1st Street, Phoenix, AZ 85048 | 2017-08-01 |
| 1497278113 | Teague Duncan Wilson | Specialist/Technologist | 3305 E Nighthawk Way, Phoenix, AZ 85048 | 2017-07-25 |
| 1730550146 | Jennifer Zazueta | Physician Assistant | 4126 E Nighthawk Way, Phoenix, AZ 85048 | 2015-10-12 |
| 1235551904 | Louise Marie Braunbeck | Physical Therapy Assistant | 16649 S 24th Place, Phoenix, AZ 85048 | 2014-01-14 |
| 1780026260 | Erin Onacki | Social Worker | 4530 E Muirwood Dr. Suite 103, Phoenix, AZ 85048 | 2013-07-24 |
| 1649528720 | Cody A Morales | Social Worker | 4654 E Mountain Vista Dr, Phoenix, AZ 85048 | 2012-08-21 |
| 1417168287 | Lori Lynn Haas | Social Worker | 4025 E. Chandler Boulevard, #70-e7, Phoenix, AZ 85048 | 2007-05-24 |
| 1285847210 | Jonne Amorette Housh | Nurse Practitioner | 4545 E Chandler Blvd., Phoenix, AZ 85048 | 2007-05-07 |
| Find all providers in zip 85048 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339200 | Madison Le | Family Medicine | 3037 W Cat Balue Dr, Phoenix, AZ 85027-2342 | 2020-09-04 |
| 1720604069 | Good Health Medical, PC | Family Medicine | 2632 S 83rd Ave Ste 113, Phoenix, AZ 85043-7206 | 2020-06-23 |
| 1427670751 | Florence Wellness Pllc | Family Medicine | 101 E Washington St Fl 7, Phoenix, AZ 85004-2450 | 2020-05-08 |
| 1437782257 | Jillian Knapp | Family Medicine | 521 W Butler Dr, Phoenix, AZ 85021-4526 | 2020-02-20 |
| 1861033912 | Vanessa Lissette Lara | Family Medicine | 1459 E Flower St, Phoenix, AZ 85014-5666 | 2019-09-30 |
| 1366007411 | Marceline E Ndum | Family Medicine | 10631 S. 51st Street, Suite 1, Phoenix, AZ 85044-5225 | 2019-05-03 |
| 1306318340 | Leah Margaret Hillier | Family Medicine | 1300 N 12th St - Suite 500, Phoenix, AZ 85006 | 2018-12-31 |
| 1326510389 | Leanne J Muniz | Family Medicine | 19635 N Cave Creek Rd Apt 344, Phoenix, AZ 85024-1879 | 2018-12-31 |
| 1164905535 | Clark Medical, Pllc | Family Medicine | 2601 N 3rd St Ste 106, Phoenix, AZ 85004-1144 | 2018-09-12 |
| 1780180901 | Babymoon Inn Family Care LLC | Family Medicine | 202 E Morris Dr, Phoenix, AZ 85012-2323 | 2018-04-05 |
| Find all providers in PHOENIX | ||||
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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.