DR. JUNG K PARK (NPI# 1700834777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700834777 |
| Entity Type | Individual |
| Full Name | DR. JUNG K PARK |
| Credential | M.D. |
| Practice Address |
11209 N Tatum Blvd Suite #110 Phoenix AZ 85028-3091 |
| Mailing Address |
Po Box 14687 Scottsdale AZ 85267-4687 |
| Practice Telephone | 6022488002 |
| Practice Fax Number | 6022488399 |
| Mailing Telephone | 4809918100 |
| Mailing Fax Number | 4809221028 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
F91378 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS | 431726 | 01 |
| AZ | BCBS | AZ0324990 | 01 |
| AZ | HEALTHNET | 1Z7049 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225569817 | Jung Park | Student in an Organized Health Care Education/Training Program | 255 Whitney Ave Apt 34, New Haven, CT 06511-3751 | 2017-03-24 |
| 1336681238 | Jung Park | Acupuncturist | 308 Preston Ave, Pasadena, TX 77503-1215 | 2016-11-08 |
| 1275783813 | Jung Sun Park | Dentist | 1860 Alcatraz, Berkeley, CA 94703 | 2008-09-19 |
| 1194919209 | Jung Hoon Park | Dentist | 5249 Duke St Ste 210, Alexandria, VA 22304-2907 | 2007-08-31 |
| 1124006523 | Jung I. Park | Specialist | 8825 Crestwood Ave, Munster, IN 46321-2711 | 2006-01-05 |
| 1942291638 | Jung Tae Park | Family Medicine | 13851 Highway 28, Whitwell, TN 37397-5373 | 2005-11-02 |
| 1679004873 | Jung Mi Park | Hospitalist | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2017-03-21 |
| 1417302621 | Jung Park | Technician/Technologist | 11112 Atlantic Ave, South Richmond Hill, NY 11419-1158 | 2016-04-26 |
| 1053601161 | Jung Eun Park | Pediatrics | 6345 Center Dr Bldg 14, Norfolk, VA 23502-4105 | 2011-04-10 |
| 1174855738 | Jung Park | Internal Medicine | 8110 Woodman Ave, Panorama City, CA 91402 | 2010-02-08 |
| Street Address |
11209 N TATUM BLVD SUITE #110 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85028-3091 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124011713 | Thomas W Bauch | Family Medicine | 11209 N Tatum Blvd, 175, Phoenix, AZ 85028-3091 | 2005-08-29 |
| 1750837050 | Jennifer Billiard | Social Worker | 11209 N Tatum Blvd, #260, Phoenix, AZ 85028-6025 | 2016-08-28 |
| 1063861060 | Matthew Wisehart | Physical Therapist | 11209 N Tatum Blvd, Ste B-120, Phoenix, AZ 85028-3091 | 2016-06-09 |
| 1861862989 | Jennifer Anne Billingsley | Nurse Practitioner | 11209 N Tatum Blvd, Suite 255, Phoenix, AZ 85028 | 2015-10-01 |
| 1467876524 | Melisa Ann Curry | Physical Therapist | 11209 N Tatum Blvd, Ste B-120, Phoenix, AZ 85028-3091 | 2014-02-10 |
| 1114267887 | Allison M Gaylor | Nurse Practitioner | 11209 N Tatum Blvd, Suite 180, Phoenix, AZ 85028-3091 | 2013-02-18 |
| 1598011785 | Jessica Lynn Giddings | Nurse Practitioner | 11209 N Tatum Blvd, Suite 260, Phoenix, AZ 85028-3091 | 2012-07-25 |
| 1518119692 | Joanne L Schlesinger | Nurse Practitioner | 11209 N Tatum Blvd, Suite 260, Phoenix, AZ 85028-3091 | 2008-10-21 |
| 1295984987 | Sonya A Bladow | Chiropractor | 11209 N Tatum Blvd, Ste 140, Phoenix, AZ 85028-3091 | 2008-09-17 |
| 1114182888 | Rakesh Kumar Bagai | Internal Medicine | 11209 N Tatum Blvd, #260, Phoenix, AZ 85028-3091 | 2008-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235626565 | Celice Korsten | Psychologist | 11020 N. Tatum Blvd., Ste. 100, Phoenix, AZ 85028 | 2018-04-23 |
| 1720591605 | Michele Kaplan | Counselor | 11640 N Tatum Blvd #3096, Phoenix, AZ 85028 | 2017-11-14 |
| 1154840304 | Faustino M. Gonzalez, Md PC | Anesthesiology | 11811 N. Tatum Blvd, Suite 3031, Phoenix, AZ 85028 | 2017-09-19 |
| 1679092514 | Savior Palliative Care LLC | Family Medicine | 4530 E Shea Blvd Ste 175, Phoenix, AZ 85028 | 2017-09-12 |
| 1437688892 | Harmony Behavioral Health | Behavioral Analyst | 3008 E Sierra St, Phoenix, AZ 85028 | 2017-06-08 |
| 1275949224 | Alexander D Garza | Podiatrist | 3101 E Shea Blvd Ste 220, Phoenix, AZ 85028 | 2014-07-09 |
| 1720418379 | Alyssa Hale | Occupational Therapy Assistant | 4600 East Shea Boulevard, Suite 101, Phoenix, AZ 85028 | 2013-11-19 |
| 1932534476 | Stephen Howard Garber | Otolaryngology | 9607 N. 43rd Way, Phoenix, AZ 85028 | 2013-09-03 |
| 1366798050 | Irna Lynn Shamos | Clinical Neuropsychologist | 4516 East Onyx Avenue, Arizona Psychological Diagnostics, Plc, Phoenix, AZ 85028 | 2012-07-31 |
| 1285930925 | Cathy Ann Payne | Nurse Practitioner | 11209 N Tatum Blvd Ste 260, Phoenix, AZ 85028 | 2011-01-27 |
| Find all providers in zip 85028 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629242425 | Nelson R. De Lara | Radiology | 26 Glen Alpine Rd, Phoenix, MD 21131-2404 | 2008-04-14 |
| 1013387208 | Compcare Medical Group Inc | Radiology | 1021 S 7th Ave, Suite 102, Phoenix, AZ 85007-3725 | 2015-09-30 |
| 1669737714 | Ankit Harish Shah | Radiology | 2601 E Roosevelt St, Phoenix, AZ 85008 | 2012-07-05 |
| 1679835128 | Curtis Qin | Radiology | 2601 E Roosevelt St, Phoenix, AZ 85008-4973 | 2012-06-11 |
| 1053615021 | Arizona Interventional Medical Group PC | Radiology | 2338 W Royal Palm Rd, Suite J, Phoenix, AZ 85021-9339 | 2011-01-05 |
| 1093954554 | Vineel Kurli | Radiology | 10835 N 25th Ave, Suite 240, Phoenix, AZ 85029-4751 | 2009-02-06 |
| 1144482886 | Ahi Cardiovascular Surgeons Ltd | Radiology | 2632 N 20th St, Phoenix, AZ 85006-1339 | 2008-06-25 |
| 1104009109 | Interventional Radiology Plc | Radiology | 1800 E Van Buren St, Phoenix, AZ 85006-3742 | 2007-12-12 |
| 1235335324 | Lavi Nissim | Radiology | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2007-06-25 |
| 1427259555 | Grace Knuttinen | Radiology | 5777 E Mayo Blvd, Phoenix, AZ 85054 | 2007-05-29 |
| 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.