Extreme medium-scale traveling ionospheric disturbances (MSTIDs) occurred at midlatitudes in East Asia during a geomagnetically active time on 10 November 2004. Using the Global Positioning System (GPS) observation data from Korean GPS reference stations, the characteristics of the MSTIDs on 10 November 2004 and their potential impact on GPS-based navigation systems in the Korean region are analyzed. The MSTIDs were first observed in the northeast part of South Korea at about 10:00 UT and propagated southwestward with successive wavefronts which extended from northwest to southeast. The peak-to-peak amplitudes of vertical total electron content (TEC) disturbances decreased from about 29 to 10 total electron content unit (1 TECU = 1016 el m−2), and the wavelengths lengthened from about 360 to 580 km from 12:53 to 14:38 UT. The propagation velocity of MSTID wavefronts was estimated using three nearby reference stations showing that velocity gradually decreased from about 254 m/s at 11:46 UT to 76 m/s at 21:26 UT. The ionospheric irregularities in small-scale regions accompanied by the MSTIDs were spatially and temporally varied from about 10:00 to 22:00 UT in response to the movement and intensity change of the MSTIDs. This event also generated anomalously large ionospheric spatial gradients which could cause unacceptable residual pseudorange errors for users of GPS augmentation systems. Frequent loss of the GPS signals, which occurred due to the intense ionospheric irregularities, could also degrade the continuity and availability of GPS-based navigation systems.