SE EUN PARK MD
NPI 1255080784
Student in an Organized Health Care Education/Training Program in Bronx, NY

Q: What is Se Eun Park's NPI number?

The NPI number for Se Eun Park is 1255080784. It was assigned to this individual provider in the NPPES registry on March 22, 2022.

Q: What is Se Eun Park's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Se Eun Park was last updated on April 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 22, 2022PECOS Enrolled

111 E 210TH ST, BRONX, NY 10467(718) 920-4417 Get Directions Write a Review

NPPES record last updated: April 4, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Se Eun Park Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SE EUN PARK MD (NPI 1255080784) is an individual student in an organized health care education/training program in Bronx, New York and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1255080784

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameSE EUN PARKCredential: MD

Location Address111 E 210TH STBronx, NY 10467-2401

Mailing Address111 E 210th StBronx, NY 10467-2401

Phone(718) 920-4417

Sole ProprietorNo

Enumeration DateMarch 22, 2022

Last NPPES UpdateApril 4, 2022

NPPES CertifiedApril 4, 2022

✔ NPI 1255080784 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

111 E 210TH ST, Bronx, NY 10467

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Se Eun Park Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEATHER ROOT MD

Internal Medicine (Infectious Disease)