JI WON PARK DMD
NPI 1255984324
Dentist - General Practice in Marietta, GA
About Ji Won Park Dmd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JI WON PARK DMD (NPI 1255984324) is an individual general practice provider in Marietta, Georgia, licensed in Georgia (DN015875) and active in the NPI registry since July 2019. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ji Won Park Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Ji Won Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Marietta, GA 30008
- Reassigned Medicare billing, Georgia enrollment
- 14 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30008 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 16
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MARIETTA, GA 30008
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 Ji Won Park's NPI number?
The NPI number for Ji Won Park is 1255984324. It was assigned to this individual provider in the NPPES registry on July 18, 2019.
Where is Ji Won Park located?
Ji Won Park practices at 1605 Roberta Dr SW, Marietta, GA 30008. The listed phone number is (770) 419-3120.
What is Ji Won Park's specialty?
The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.
Is Ji Won Park enrolled in Medicare?
Yes. Ji Won Park is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Ji Won Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ji Won Park reassigns Medicare benefits to Good Samaritan Health Center Of Cobb (Marietta, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ji Won Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Ji Won Park was last updated on July 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Ji Won Park, DMD · NPI 1255984324
General Practice provider in Marietta, Georgia. Individual provider, active in the CMS NPPES registry since July 18, 2019.
## Identity
- **NPI:** 1255984324 (Entity type: Individual)
- **Enumerated:** July 18, 2019
- **Primary specialty:** Dentist - General Practice · taxonomy 1223G0001X
- **State license:** DN015875 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 1605 ROBERTA DR SW, Marietta, GA 30008-3855
- **Phone:** (770) 419-3120
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Good Samaritan Health Center Of Cobb (NPI 1881923126, Marietta, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 18, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1255984324) · Data from the CMS NPPES public registry.