Dr. John Moonkeun Park
Surgeon Vascular Surgeon
515 N 162nd Ave Ste. 300
Omaha
, Nebraska 68118-2539
Dr. John Moonkeun Park
Surgeon Vascular Surgeon
515 N 162nd Ave Ste. 300
Omaha
, Nebraska 68118-2539
(402) 354-2155
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About
Features
Specialties
- Surgeon
- Vascular Surgeon
Languages spoken
- English
Location
First Address
- Dr. John Moonkeun Park
- Po Box 3755
- Omaha, NE
- Zip : 68103-0755
- Fax : (402) 354-2155
- Phone : (402) 354-2100
Second Address
- Dr. John Moonkeun Park
- 515 N 162nd Ave Ste. 300
- Omaha, NE
- Zip : 68118-2539
- Fax : (402) 393-6635
- Phone : (402) 393-6624
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 208200000X | Surgeon | 35.095909 | OH |
| N | 208600000X | Surgeon | 35.095909 | OH |
| Y | 2086S0129X | Vascular Surgeon | 26509 | NE |
| N | 2086S0129X | Vascular Surgeon | 35.095909 | OH |
| N | 2086S0129X | Vascular Surgeon | 40563 | IA |
National Provider Identifier
| NPI | 1023394665 |
|---|---|
| Provider Name | Dr. John Moonkeun Park |
| First Address | Omaha, NE 68103-0755 |
| Second Address | Omaha, NE 68118-2539 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/10/2011 |
| Last Update Date | 20/02/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 10025724800 | (05) | NE |
| 10026135100 | (05) | NE |
| 10026454700 | (05) | NE |
| 1023394665 | (05) | IA |
| 47068731713 | (05) | NE |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.