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DR. GRACE JIYOUNG PARK D.O. , MPH
NPI 1164677464
Family Medicine in Gardena, CA

Active since December 01, 2008PECOS EnrolledAccepts Medicare Assignment
15446 S WESTERN AVE, SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP, GARDENA, CA 90249(310) 965-4821 Get Directions Write a Review

NPPES record last updated: December 6, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Grace Jiyoung Park D.o. , Mph NPPES

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

DR. GRACE JIYOUNG PARK D.O. , MPH (NPI 1164677464) is an individual family medicine provider in Gardena, California, licensed in California (20A10562) and active in the NPI registry since December 2008. She is enrolled in Medicare PECOS and is a graduate of Other (2007).

NPPES Registry Identity

NPI1164677464
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. GRACE JIYOUNG PARKCredential: D.O. , MPH
Location Address15446 S WESTERN AVE, SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUPGardena, CA 90249-4319
Mailing Address15446 S Western Ave, Southern California Permanente Medical GroupGardena, CA 90249-4319 · (310) 965-4821
Phone(310) 965-4821
Sole ProprietorNo
Medical School CMSOtherGraduated 2007
Enumeration DateDecember 1, 2008
Last NPPES UpdateDecember 6, 2021
✔ NPI 1164677464 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · 20A10562
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
15446 S WESTERN AVE, Gardena, CA 90249
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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

Dr. Grace Jiyoung Park D.o. , Mph 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 ID2668668864
PECOS Enrollment IDI20101130001131
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 90249 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
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
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 20

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

DR. FREYMAN MANUEL RECINOS M.D.
Family Medicine
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (800) 780-1230
NORIKO LEE
Pharmacist
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 217-5315
CECILIA CHANG RAJU OD
Optometrist
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 217-5370
DR. KEILA JENAE TRIMBLE-COX MD
Pediatrics
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 965-4826
DR. LINDSEY MARIKO TAYLOR DPT
Physical Therapist
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 217-5378
TIANA TRUONG
Pharmacist
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 217-5315
DR. EMILY NGUYEN PHARM D
Pharmacist
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 217-5315
PETER CHONG MD
Internal Medicine
15446 S WESTERN AVE
GARDENA, CA 90249
Los Angeles County (310) 217-5470

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 Grace Park's NPI number?

The NPI number for Grace Park is 1164677464. It was assigned to this individual provider in the NPPES registry on December 1, 2008.

Where is Grace Park located?

Grace Park practices at 15446 S Western Ave Southern California Permanente Medical Group, Gardena, CA 90249. The listed phone number is (310) 965-4821.

What is Grace Park's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Grace Park enrolled in Medicare?

Yes. Grace 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 Grace Park was last updated on December 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.