DR. JAEHYEON PARK (NPI# 1447802681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447802681 |
| Entity Type | Individual |
| Full Name | DR. JAEHYEON PARK |
| Credential | MD |
| Practice Address |
102 W Kenwood Ave Ste 100 Decatur IL 62526-4379 |
| Practice Telephone | 2178723800 |
| Practice Fax Number | 2178720849 |
| Mailing Telephone | 2178723800 |
| Mailing Fax Number | 2178720849 |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2019-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 125-075031 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
102 W KENWOOD AVE STE 100 |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-4379 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275976094 | Zachary James Shipp | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2013-04-11 |
| 1043828296 | Amna Karim | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2020-07-14 |
| 1245857861 | Abhijeet S Joshi | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2020-06-30 |
| 1952925273 | Nikhil R Vatti | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2020-06-02 |
| 1295359503 | Adrine A Markosyan | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2020-06-02 |
| 1932723269 | Moomal P Shaikh | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2020-06-02 |
| 1538792262 | Jordyn Mathias | Counselor | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2020-02-21 |
| 1568024867 | Samantha A Agar | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2019-07-08 |
| 1821650730 | Abhinay Walia | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2019-07-01 |
| 1225699671 | Benjamin Ford | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2019-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| 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 |
|---|---|---|---|---|
| 1982170817 | Health-e LLC | Family Medicine | 1466 Country Squire Dr, Decatur, GA 30033-2414 | 2018-10-18 |
| 1548772536 | D'neka Colzie | Family Medicine | 2663 Easterly Pl, Decatur, GA 30035-4004 | 2017-10-30 |
| 1356862551 | Amruta Dutia | Family Medicine | 102 W Kenwood Ave Ste 102, Decatur, IL 62526-4380 | 2017-06-28 |
| 1962938043 | Atlanta Functional & Integrative Medicine | Family Medicine | 2786 N Decatur Rd, Decatur, GA 30033-5928 | 2017-05-10 |
| 1194179341 | Alexander Bryant Mcqueen | Family Medicine | 2422 Danville Rd Sw Ste E, Decatur, AL 35603-4221 | 2016-04-13 |
| 1609259969 | Vitale Medical Inc | Family Medicine | 3290 Memorial Dr Ste B1, Decatur, GA 30032-3400 | 2015-07-06 |
| 1427465434 | Martha Read | Family Medicine | 2208 Danville Rd Sw Ste A, Decatur, AL 35601 | 2014-07-22 |
| 1881036879 | Brigitte B. Nahmias | Family Medicine | 114 Mckoy St, Decatur, GA 30030-4346 | 2013-07-19 |
| 1275976094 | Zachary James Shipp | Family Medicine | 102 W Kenwood Ave Ste 100, Decatur, IL 62526-4379 | 2013-04-11 |
| 1790023497 | Philip Henry Sharkey | Family Medicine | 4666 E Powers Blvd, Decatur, IL 62521-2549 | 2013-01-30 |
| Find all providers in DECATUR | ||||
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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.