MICHELLE MYOUNGWOO PARK (NPI# 1346616745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346616745 |
| Entity Type | Individual |
| Full Name | MICHELLE MYOUNGWOO PARK |
| Credential | NP, RN |
| Practice Address |
3075 Adeline St Ste 280 Berkeley CA 94703-2580 |
| Practice Telephone | 5109814100 |
| Mailing Telephone | 5109814100 |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 847491 | CA | Nursing Service Providers |
| N | 163WC1500X |
Registered Nurse Specialization: Community Health |
87621 | CA | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95002767 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811525785 | Michelle S Park | Marriage & Family Therapist | 3801 23rd Ave Ste 415, Astoria, NY 11105-1532 | 2020-03-27 |
| 1740694918 | Michelle E Park | Dermatology | 2 5th Ave Unit 2, New York, NY 10011-8856 | 2014-06-16 |
| 1114579083 | Michelle Park | Counselor | 2730 Sw Pacific Boulevard, Albany, OR 97321 | 2019-07-11 |
| 1558925743 | Michelle Jungae Park | Nurse Practitioner | 4995 Lanier Islands Pkwy, Buford, GA 30518-1741 | 2019-04-24 |
| 1851895965 | Michelle Hae-min Park | Student in an Organized Health Care Education/Training Program | 2000 W Bethany Home Rd, Phoenix, AZ 85015-2443 | 2018-03-22 |
| 1811428667 | Michelle Park | Student in an Organized Health Care Education/Training Program | 101 The City Dr S, City Tower, Ste 400, Orange, CA 92868-3201 | 2017-03-23 |
| 1265976872 | Michelle Ju Hyun Park | Pharmacist | 4601 Dale Rd, Modesto, CA 95356-9718 | 2016-12-15 |
| 1639613045 | Michelle Hansol Park | Pharmacist | 2690 Pacific Coast Hwy, Torrance, CA 90505-7038 | 2016-12-05 |
| 1366819708 | Michelle Anna Park | Pharmacist | 12254 Bellflower Blvd, Downey, CA 90242-2804 | 2015-09-01 |
| 1528336039 | Michelle Park | Pharmacist | 22930 S Western Ave, Torrance, CA 90501-5112 | 2011-12-12 |
| Street Address |
3075 ADELINE ST STE 280 |
| City | BERKELEY |
| State | CA |
| Zip Code | 94703-2580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760707756 | Xaviera Ortiz Soto | Internal Medicine | 3075 Adeline St Ste 280, Berkeley, CA 94703-2580 | 2010-04-01 |
| 1437791449 | Lifelong Medical Care | Non-Pharmacy Dispensing Site | 3075 Adeline St Ste 280, Berkeley, CA 94703-2580 | 2019-10-10 |
| 1205281094 | Jessica Van Kessel | Registered Nurse | 3075 Adeline St Ste 280, Berkeley, CA 94703-2580 | 2016-04-28 |
| 1417301581 | Sarah Cluff | Registered Nurse | 3075 Adeline St Ste 280, Berkeley, CA 94703-2580 | 2016-04-14 |
| 1336528249 | Nicole Sata | Registered Nurse | 3075 Adeline St Ste 280, Berkeley, CA 94703-2580 | 2015-05-26 |
| 1457758724 | Lifelong Medical Care | Dentist | 3075 Adeline St Ste 280, Berkeley, CA 94703-2580 | 2014-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811553621 | Brittney Jerrilena Monique Garrett | Behavioral Analyst | 1901 Stuart St, Berkeley, CA 94703 | 2019-05-16 |
| 1740762178 | Maryam Jabbari Amiri | Student in an Organized Health Care Education/Training Program | 3075 Adeline Street, Suite 120, Berkeley, CA 94703 | 2018-09-01 |
| 1619427549 | Sigal Gafni | Occupational Therapist | 1622 Parker St. Apt. 1, Berkeley, CA 94703 | 2016-10-04 |
| 1750741138 | Ane Becker | Community Health Worker | 2026 Woolsey St, Berkeley, CA 94703 | 2016-02-29 |
| 1245697135 | Sara Dinome Teel Vargas | Chiropractor | 3286 Adeline St., Suite 9, Berkeley, CA 94703 | 2016-01-22 |
| 1083081608 | Olivia Debree | Nurse Practitioner | 3075 Adeline Street, Suite 280, Lifelong Medical Care, Ashby Health Center, Berkeley, CA 94703 | 2015-08-31 |
| 1962885988 | Caro Grosvenor | Marriage & Family Therapist | 1511 Ada Street, Berkeley, CA 94703 | 2015-07-08 |
| 1619378452 | Myles Malone | Counselor | 2413 Jefferson Ave., Berkeley, CA 94703 | 2014-09-11 |
| 1013340223 | Denise Daniel | Acupuncturist | 6222 La Salle Ave Suite B, Oakland, CA 94703 | 2013-08-12 |
| 1104126200 | Iramis Kouromenos | Dental Hygienist | 1721 University Ave Apt#209, Berkeley, CA 94703 | 2010-10-25 |
| Find all providers in zip 94703 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861967622 | Liliana Teves Sierra | Nurse Practitioner | 837 Addison St, Berkeley, CA 94710 | 2018-10-09 |
| 1295210995 | Brian Christopher Vassalo | Nurse Practitioner | 1528 Woolsey St Apt D, Berkeley, CA 94703-2353 | 2018-09-27 |
| 1942710140 | Laila Rania Tannura | Nurse Practitioner | 837 Addison St., Berkeley, CA 94710 | 2017-10-03 |
| 1275063323 | Alice Mak | Nurse Practitioner | 3154 College Ave Apt 2, Berkeley, CA 94705-2747 | 2017-06-12 |
| 1174996839 | Niccole Blanchet | Nurse Practitioner | 3095 Telegraph Ave, Berkeley, CA 94705-2035 | 2015-11-03 |
| 1497996953 | Tamra Leigh Groode | Nurse Practitioner | 2701 Martin Luther King Jr Way, Berkeley, CA 94703-2165 | 2009-03-13 |
| 1306066576 | Gretchen Leslie Meyer | Nurse Practitioner | 2016 Delaware St # A, Berkeley, CA 94709-2122 | 2007-04-27 |
| 1285765313 | Mythilla Karunaratne | Nurse Practitioner | 2999 Regent St Ste 425, Berkeley, CA 94705-2119 | 2007-03-08 |
| 1144358532 | Pam Elizabeth Cameron | Nurse Practitioner | University Health Servcices 2222 Bancroft Way, Berkeley, CA 94720-4300 | 2007-02-28 |
| 1497851653 | Maile Concolino Matier | Nurse Practitioner | 2222 Bancroft Ext # 4300, Berkeley, CA 94720-4300 | 2006-09-15 |
| Find all providers in BERKELEY | ||||
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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.