Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Koji Park, MD

Individual provider Surgery Physician · NPI 1124343694

Dr. Koji Park, MD is a General Surgery in New York, New York. Graduated from State University of New York Downstate Medical Center in 2007, 19 years ago. Practices with Icahn School of Medicine at Mount Sinai, a 2,791-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
19
Trained at
State University of New York Downstate Medical Center
Licensed in
NY
In the registry since
2010
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1111 Amsterdam Ave 4W
New York, NY 10025-1716
Phone: (212) 636-1000
Fax: (212) 523-2351
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 276066 (NY)

Record details

NPI number1124343694
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 28, 2010
Last updated in NPPESJune 2, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolSTATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER
Graduated 2007 (19 years in practice)
Group practice Icahn School Of Medicine At Mount Sinai — 2791 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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