DR. JI-KWAN PARK (NPI# 1619322898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1619322898 |
Entity Type | Individual |
Full Name | DR. JI-KWAN PARK |
Other Name | DR. JI KWAN PARK |
Credential | MD, MPH |
Practice Address |
555 N 13th Ave Upland CA 91786-4904 |
Practice Telephone | 9092772420 |
Practice Fax Number | 9092061097 |
Mailing Telephone | 9092772420 |
Mailing Fax Number | 9092061097 |
Enumeration Date | 2016-04-26 |
Last Update Date | 2020-07-23 |
NPI Deactivation Date | 07/07/2020 |
NPI Reactivation Date | 2020-07-22 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207W00000X | Ophthalmology | A155176 | CA | Allopathic & Osteopathic Physicians |
N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
Address | Telephone Number | Fax Number |
---|---|---|
333 City Blvd W, Suite 400, Orange, CA 928682903 | 7144566693 |
Street Address |
555 N 13TH AVE |
City | UPLAND |
State | CA |
Zip Code | 91786-4904 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093744351 | Kamyar Safdari | Anesthesiology | 555 N 13th Ave, Upland, CA 91786-4904 | 2006-06-30 |
1669979001 | Sharon Liao | Student in an Organized Health Care Education/Training Program | 555 N 13th Ave, Upland, CA 91786-4904 | 2018-04-11 |
1225488612 | Brian Alva | Optometrist | 555 N 13th Ave, Upland, CA 91786-4904 | 2016-06-15 |
1083060248 | Visionary Care Anesthesia Associates Inc | Anesthesiology | 555 N 13th Ave, Upland, CA 91786-4904 | 2016-05-06 |
1164809851 | Ryan Gregory Smith | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2015-05-01 |
1912249970 | Charisse Chin | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2013-03-18 |
1225391725 | Edward Stephen Yung | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2012-06-19 |
1720379100 | Samuel C. Kim | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2011-04-20 |
1679707665 | Mila Jacoba Heersink | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2009-05-06 |
1740468263 | Peter D Bekendam | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2008-02-06 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366093254 | California Clinics, Inc | Physical Medicine & Rehabilitation | 818 N Mountain Ave Ste 102, Upland, CA 91786 | 2019-09-23 |
1699231621 | Lynn Keitz | Nurse Practitioner | 360 East 7th Street, Suite D, Upland, CA 91786 | 2019-02-14 |
1003386608 | Devin A Lockett | Counselor | 916 N, Mountain Ave. Suite D-1, Upland, CA 91786 | 2018-11-27 |
1265900096 | Right Ride | Driver | 1023 West Arrow Hwy Apt A, Upland, CA 91786 | 2018-11-09 |
1689142069 | Mike Sedat Safi | Driver | 1023 W Arrow Hwy, Apt A, Upland, CA 91786 | 2018-11-05 |
1902373640 | Barsoum Dental | Dentist | 258 E. 9th Street, Upland, CA 91786 | 2018-10-31 |
1346736600 | Jennifer Lynn Henshaw | Counselor | Rosewood Counseling Center, 288 W 9th Street, Upland, CA 91786 | 2018-07-10 |
1972099521 | Sadeg Aldolaim | Nurse Practitioner | 2086 W Arrow Route, Apt 824, Upland, CA 91786 | 2018-07-06 |
1831607332 | Sandra Sun | Pharmacist | 1445 E. Foothill Blvd., Upland, CA 91786 | 2018-01-18 |
1841713625 | Dynamic Performance Physical Therapy Inc | Clinic/Center | 2377 W. Foothill Blvd, Ste 20, Upland, CA 91786 | 2017-07-24 |
Find all providers in zip 91786 |
Taxonomy Code | 207W00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Ophthalmology |
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508177221 | Terry Kang | Ophthalmology | 1246 E Arrow Hwy Ste A, Upland, CA 91786-4955 | 2010-06-28 |
1457457483 | Marc Howard Shomer | Ophthalmology | 820 N Mountain Ave Ste 102, Upland, CA 91786-4163 | 2006-09-16 |
1629044185 | Lance Mitchell Siegel | Ophthalmology | 1246 E Arrow Hwy, Ste A, Upland, CA 91786-4955 | 2006-02-24 |
1164809851 | Ryan Gregory Smith | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2015-05-01 |
1912249970 | Charisse Chin | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2013-03-18 |
1225391725 | Edward Stephen Yung | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2012-06-19 |
1720379100 | Samuel C. Kim | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2011-04-20 |
1679707665 | Mila Jacoba Heersink | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2009-05-06 |
1740468263 | Peter D Bekendam | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2008-02-06 |
1821188996 | Jesse Dovich | Ophthalmology | 555 N 13th Ave, Upland, CA 91786-4904 | 2006-10-12 |
Find all providers in UPLAND |
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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.