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DR. JAE SUNG PARK D.M.D.
NPI 1134551716
Dentist - General Practice in Rock Hill, SC

Active since August 06, 2013PECOS Enrolled
1578 CONSTITUTION BLVD, SUITE 01, ROCK HILL, SC 29732(803) 366-1456(803) 324-0117 Get Directions Write a Review

NPPES record last updated: December 24, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 24, 2020, Dec 7, 2015 (2 updates tracked since 2015).

About Dr. Jae Sung Park D.m.d. NPPES

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

DR. JAE SUNG PARK D.M.D. (NPI 1134551716) is an individual general practice provider in Rock Hill, South Carolina, licensed in South Carolina (DGD.8288 GD) and active in the NPI registry since August 2013. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1134551716
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. JAE SUNG PARKCredential: D.M.D.
Location Address1578 CONSTITUTION BLVD, SUITE 01Rock Hill, SC 29732-3543
Mailing Address1578 Constitution Blvd, Suite 01Rock Hill, SC 29732-3543 · (803) 366-1456
Phone(803) 366-1456
Fax(803) 324-0117
Sole ProprietorNo
Enumeration DateAugust 6, 2013
Last NPPES UpdateDecember 24, 20202 updates tracked since enumeration
NPPES CertifiedDecember 24, 2020
✔ NPI 1134551716 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in SC · DGD.8288 GD
Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

1578 CONSTITUTION BLVD, Rock Hill, SC 29732
Open in Google Maps ↗

Other Identifiers 1

MedicaidZX8288SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and more.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)

Dr. Jae Sung Park D.m.d. 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 29732 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
$83.18 typical visit price
range $53.57 – $163.84
Typical copayment $20.79 (range $13.39 – $40.96)
Most-billed visit code 99203
Established Patient
$67.12 typical visit price
range $16.96 – $133.52
Typical copayment $16.78 (range $4.24 – $33.38)
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.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PALMETTO SURGERY LLC
Surgery
1578 CONSTITUTION BLVD, 01
ROCK HILL, SC 29732
York County (803) 324-5858
PARK DENTAL GROUP, LLC
Dentist (General Practice)
1578 CONSTITUTION BLVD, STE 01
ROCK HILL, SC 29732
York County (803) 366-1456

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 Jae Sung Park's NPI number?

The NPI number for Jae Sung Park is 1134551716. It was assigned to this individual provider in the NPPES registry on August 6, 2013.

Where is Jae Sung Park located?

Jae Sung Park practices at 1578 Constitution Blvd Suite 01, Rock Hill, SC 29732. The listed phone number is (803) 366-1456.

What is Jae Sung Park's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Jae Sung Park enrolled in Medicare?

Yes. Jae Sung Park is registered in the Medicare PECOS enrollment system.

What insurance does Jae Sung Park accept?

Health plans from Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee, Anthem Blue Cross and Blue Shield and BEST Life and 14 other insurers list Jae Sung 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 Jae Sung Park was last updated on December 24, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.