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

Tony Jungwoo Park

Individual provider Registered Nurse · NPI 1144686577

Tony Jungwoo Park is a Nurse Practitioner in Buena Park, California. Qualified in 2020, 6 years ago. Practices with Kcs, Inc, a 16-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2016
Specialties on file
3
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Practice location Address checks out

7212 Orangethorpe Ave Ste 9A
Buena Park, CA 90621-4668
Phone: (714) 503-6550
Fax: (714) 409-3075
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 2020011541 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 835101 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 95003723 (CA)

Record details

NPI number1144686577
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 14, 2016
Last updated in NPPESNovember 4, 2024
Certification dateNovember 4, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Kcs, Inc. — 16 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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