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BALY JUAN SEO PARK
NPI 1790403137
Student in an Organized Health Care Education/Training Program in Farmington, CT

Active since August 22, 2022PECOS Enrolled
263 FARMINGTON AVE, FARMINGTON, CT 06030(679) 860-2000 Get Directions Write a Review

NPPES record last updated: September 6, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 6, 2022, Aug 22, 2022 (2 updates tracked since 2022).

About Baly Juan Seo Park NPPES

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

BALY JUAN SEO PARK (NPI 1790403137) is an individual student in an organized health care education/training program in Farmington, Connecticut, licensed in Connecticut (13568) and active in the NPI registry since August 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790403137
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameBALY JUAN SEO PARK
Location Address263 FARMINGTON AVEFarmington, CT 06030-0001
Mailing Address10 Talcott Ridge Rd Unit GFarmington, CT 06032-3513 · (959) 225-0288
Phone(679) 860-2000
Sole ProprietorNo
Enumeration DateAugust 22, 2022
Last NPPES UpdateSeptember 6, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 6, 2022
✔ NPI 1790403137 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
License✔ Licensed in CT · 13568
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.
263 FARMINGTON AVE, Farmington, CT 06030
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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)

Baly Juan Seo Park 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.

STATE OF CONNECTICUT HEALTH CENTER
Pathology (Anatomic Pathology & Clinical Pathology)
263 FARMINGTON AVE, LABORATORY HBP GROUP
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-7503
MR. IAN THOMAS MCNEILL
Neurological Surgery
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-8080
DR. LUIS CHAVEZ DE PAZ DDS, MS, PHD
Dentist (Endodontics)
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-2719
TARUNYA REDDY VEDERE
Internal Medicine (Endocrinology, Diabetes & Metabolism)
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-3245
ZACHARY TALLENT SOLOMON
Surgery
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-3467
MICHAEL CONNOLLY
Psychiatry & Neurology (Psychiatry)
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-4733
EMILY WENG DO
Internal Medicine (Gastroenterology)
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-3158
ANDREW KEMERLEY DO
Student in an Organized Health Care Education/Training Program
263 FARMINGTON AVE
FARMINGTON, CT 06030
Capitol Planning Region (860) 679-3467

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Baly Seo Park's NPI number?

The NPI number for Baly Seo Park is 1790403137. It was assigned to this individual provider in the NPPES registry on August 22, 2022.

Where is Baly Seo Park located?

Baly Seo Park practices at 263 Farmington Ave, Farmington, CT 06030. The listed phone number is (679) 860-2000.

What is Baly Seo Park's specialty?

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

Is Baly Seo Park enrolled in Medicare?

Yes. Baly Seo Park is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Baly Seo Park was last updated on September 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.