1. Home
  2. Directory
  3. California
  4. Rancho Cucamonga
  5. Physician Assistant
  6. NPI Profile

SUNYOUNG PARK LAC.
NPI 1114080801
Physician Assistant in Rancho Cucamonga, CA

Active since December 18, 2006PECOS EnrolledAccepts Medicare Assignment
10801 FOOTHILL BLVD. # 104, RANCHO CUCAMONGA, CA 91730(909) 989-4435(909) 989-4461 Get Directions Write a Review

NPPES record last updated: January 11, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Sunyoung Park Lac. NPPES

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

SUNYOUNG PARK LAC. (NPI 1114080801) is an individual physician assistant in Rancho Cucamonga, California and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1114080801
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameSUNYOUNG PARKCredential: LAC.
Location Address10801 FOOTHILL BLVD. # 104Rancho Cucamonga, CA 91730
Mailing Address10801 Foothill Blvd. # 104Rancho Cucamonga, CA 91730 · (909) 989-4435 · Fax (909) 989-4461
Phone(909) 989-4435
Fax(909) 989-4461
Sole ProprietorYes
Medical School CMSOtherGraduated 2020
Enumeration DateDecember 18, 2006
Last NPPES UpdateJanuary 11, 2021
NPPES CertifiedJanuary 11, 2021
✔ NPI 1114080801 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Also ListedAcupuncturistTaxonomy 171100000X · License 11452 (CA)
10801 FOOTHILL BLVD. # 104, Rancho Cucamonga, CA 91730
Open in Google Maps ↗

Other Names 1

Other Name (5)Kathleen Kim Lac

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sunyoung Park Lac. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6608275789
PECOS Enrollment IDI20210521000618
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 91730 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
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$74.08 typical visit price
range $19.37 – $146.42
Typical copayment $18.52 (range $4.84 – $36.60)
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 Sunyoung Park's NPI number?

The NPI number for Sunyoung Park is 1114080801. It was assigned to this individual provider in the NPPES registry on December 18, 2006. The provider is also known as Kathleen Kim Lac.

Where is Sunyoung Park located?

Sunyoung Park practices at 10801 Foothill Blvd. # 104, Rancho Cucamonga, CA 91730. The listed phone number is (909) 989-4435.

What is Sunyoung Park's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Sunyoung Park enrolled in Medicare?

Yes. Sunyoung Park is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Sunyoung Park was last updated on January 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.