NPI Code Detail JSON Logo

1003153024 NPI number — SUNGKUK PARK M.S., CCC-SLP

NPI Number: 1003153024
Health Care Provider/Practitioner: SUNGKUK PARK M.S., CCC-SLP

Information about “1003153024” NPI (SUNGKUK PARK M.S., CCC-SLP) exists in 1003153024 in HTML format HTML  |  1003153024 in plain Text format TXT  |  1003153024 in PDF (Portable Document Format) PDF  |  1003153024 in an XML format XML  formats.

NPI Number : 1003153024 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003153024",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PARK",
    "FirstName": "SUNGKUK",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6111 QUEENS BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODSIDE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11377-4965",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-205-0288",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4320 MURRAY ST FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLUSHING",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11355-1330",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-578-8708",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/10/2013",
    "LastUpdateDate": "11/06/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "023032",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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