MR. ANDREW JAE-MIN PARK MD
NPI 1376167643
Student in an Organized Health Care Education/Training Program in Rochester, NY

Q: What is Andrew Park's NPI number?

The NPI number for Andrew Park is 1376167643. It was assigned to this individual provider in the NPPES registry on June 2, 2020.

Q: What is Andrew 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 Andrew Park was last updated on April 27, 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 June 02, 2020PECOS Enrolled

777 CLINTON AVE S, ROCHESTER, NY 14620(555) 279-4800 Get Directions Write a Review

NPPES record last updated: April 27, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 27, 2022, Jun 2, 2020 (2 updates tracked since 2020).

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About Mr. Andrew Jae-min Park Md NPPES

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

MR. ANDREW JAE-MIN PARK MD (NPI 1376167643) is an individual student in an organized health care education/training program in Rochester, New York and active in the NPI registry since June 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376167643

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMR. ANDREW JAE-MIN PARKCredential: MD

Location Address777 CLINTON AVE SRochester, NY 14620-1448

Mailing Address777 Clinton Ave SRochester, NY 14620-1448 · (585) 279-4800

Phone(555) 279-4800

Sole ProprietorNo

Enumeration DateJune 2, 2020

Last NPPES UpdateApril 27, 20222 updates tracked since enumeration

NPPES CertifiedApril 27, 2022

✔ NPI 1376167643 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.

777 CLINTON AVE S, Rochester, NY 14620

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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)

Mr. Andrew Jae-min 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.

SOPHIA EMMANUELLE HANNA DO

Student in an Organized Health Care Education/Training Program