MR. JUNG TAE PARK (NPI# 1942291638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1942291638 |
Entity Type | Individual |
Full Name | MR. JUNG TAE PARK |
Credential | MD |
Practice Address |
13851 Highway 28 Whitwell TN 37397-5373 |
Mailing Address |
Po Box 400 13851 Highway 28 Whitwell TN 37397-0400 |
Practice Telephone | 4236589200 |
Practice Fax Number | 4236582195 |
Mailing Telephone | 4236589200 |
Mailing Fax Number | 4236582195 |
Enumeration Date | 2005-11-02 |
Last Update Date | 2008-11-18 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
MD0000010100 | TN | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | B CARE | 2002139 | 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 |
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 |
1659517902 | Jung Park | Orthopaedic Surgery | 3401 N Broad St, Outpatient Building 6th Fl., Philadelphia, PA 19140-5103 | 2008-12-16 |
Street Address |
13851 HIGHWAY 28 |
City | WHITWELL |
State | TN |
Zip Code | 37397-5373 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225409147 | Whitwell Medical Plaza | Clinic/Center | 13851 Highway 28, Whitwell, TN 37397-5373 | 2015-10-19 |
1356745848 | Kimberly Gean Redfearn | Nurse Practitioner | 13851 Highway 28, Whitwell, TN 37397-5373 | 2014-10-13 |
1083982243 | Brenda Ross Md PC | Family Medicine | 13851 Highway 28, Whitwell, TN 37397-5373 | 2011-12-02 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760972202 | Specialized Behavior Solutions | Behavioral Analyst | 360 Looneys Creek Dr, Whitwell, TN 37397 | 2018-05-10 |
1134285125 | Frederick Kirk Mcdermott | Counselor | 13810 Hwy 28, Suite B, Whitwell, TN 37397 | 2006-12-28 |
1295811156 | Hooper Drug Store | Pharmacist | 325 E. Spring Street Po 129, Whitwell, TN 37397-0129 | 2006-10-31 |
1477627768 | Whitwell Pharmacy Inc | Pharmacy | 13810 Highway 28, Whitwell, TN 37397-5365 | 2006-11-20 |
1689961104 | Whitwell Senior Living, LLC | Assisted Living Facility | 13960 Highway 28, Whitwell, TN 37397-5366 | 2011-07-05 |
1043271091 | Nonie Ivey Linder | Social Worker | 720 Teague Rd, Whitwell, TN 37397-5982 | 2006-03-29 |
1447471909 | Ingrid Rene Long | Registered Nurse | 295 Scissomtown Rd, Whitwell, TN 37397-6601 | 2007-05-01 |
1083228209 | Tarrah Davis | Nurse Practitioner | 205 Fiddlers Dr, Whitwell, TN 37397-8918 | 2020-09-04 |
Taxonomy Code | 207QA0505X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Adult Medicine |
Definition to come. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750902177 | R&m Consultants LLC | Family Medicine | 208 N Roan St, Johnson City, TN 37601-4735 | 2020-04-27 |
1124656616 | Carebridge Medical Group, PC | Family Medicine | 926 Main St Ste B, Nashville, TN 37206-3614 | 2020-03-30 |
1104456052 | Briana Arnett | Family Medicine | 2308 Memorial Blvd Ste D, Springfield, TN 37172-3929 | 2020-01-20 |
1326552225 | Tiffany Danielle Turner | Family Medicine | 1045 Horse Head Lane, Pikeville, TN 37367 | 2017-11-30 |
1871928556 | Shirley Gravenor | Family Medicine | 2636 Park Creek Dr, Germantown, TN 38139-6556 | 2013-09-12 |
1952733396 | Unity Health Home, Inc | Family Medicine | 201 Jordan Rd, Suite 200, Franklin, TN 37067-4495 | 2013-08-08 |
1447503842 | Charlene Crowder Matthews | Family Medicine | 157 Highway 25 E, Newport, TN 37821-8157 | 2012-10-23 |
1295007730 | Anthony Glen Justice | Family Medicine | 11911 Kingston Pike, Suite 201, Knoxville, TN 37934-4602 | 2012-01-30 |
1386878957 | Holly Spurlock Blankenship | Family Medicine | 370 Doolittle Rd Ste 1, Woodbury, TN 37190-1129 | 2009-05-11 |
1447454525 | Gay Kirchner Battle | Family Medicine | 2309 Granite Dr, Johnson City, TN 37604-2172 | 2007-06-13 |
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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.