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RENEE YOOSUN PARK DDS
NPI 1073526794
Dentist in San Diego, CA

Active since August 14, 2006PECOS Enrolled
10255 BLACK MOUNTAIN RD, #P4, SAN DIEGO, CA 92126(510) 290-2260 Get Directions Write a Review

NPPES record last updated: April 22, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Renee Yoosun Park Dds NPPES

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

RENEE YOOSUN PARK DDS (NPI 1073526794) is an individual dentist in San Diego, California, licensed in California (54005) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073526794
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameRENEE YOOSUN PARKCredential: DDS
Location Address10255 BLACK MOUNTAIN RD, #P4San Diego, CA 92126-3866
Mailing Address10255 Black Mountain Rd, #p4San Diego, CA 92126-3866 · (510) 290-2260
Phone(510) 290-2260
Sole ProprietorYes
Enumeration DateAugust 14, 2006
Last NPPES UpdateApril 22, 2014
✔ NPI 1073526794 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Licenses✔ Licensed in CA · 54005✔ Licensed in NY · 055807-1
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
10255 BLACK MOUNTAIN RD, San Diego, CA 92126
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Renee Yoosun Park Dds 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92126 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Renee Park's NPI number?

The NPI number for Renee Park is 1073526794. It was assigned to this individual provider in the NPPES registry on August 14, 2006.

Where is Renee Park located?

Renee Park practices at 10255 Black Mountain Rd #p4, San Diego, CA 92126. The listed phone number is (510) 290-2260.

What is Renee Park's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Renee Park enrolled in Medicare?

Yes. Renee Park is registered in the Medicare PECOS enrollment system.

What insurance does Renee Park accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Renee Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Renee Park was last updated on April 22, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.