JI WON PARK DMD
NPI 1255984324
Dentist - General Practice in Marietta, GA

Q: 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.

Q: What is Ji Won Park's specialty?

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

Q: 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.

Active since July 18, 2019PECOS Enrolled

1605 ROBERTA DR SW, MARIETTA, GA 30008(770) 419-3120 Get Directions Write a Review

NPPES record last updated: July 18, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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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

NPI1255984324

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameJI WON PARKCredential: DMD

Location Address1605 ROBERTA DR SWMarietta, GA 30008-3855

Mailing Address11 Perimeter Ctr E Apt 2304Atlanta, GA 30346-1650 · (404) 428-4851

Phone(770) 419-3120

Sole ProprietorNo

Enumeration DateJuly 18, 2019

✔ NPI 1255984324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in GA · DN015875

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.

1605 ROBERTA DR SW, Marietta, GA 30008

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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 (PECOS)

Ji Won Park Dmd 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 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.

New Patient

$88.06 typical visit price

range $56.84 – $172.43

Typical copayment $22.01 (range $14.21 – $43.10)

Most-billed visit code 99203

Established Patient

$70.85 typical visit price

range $18.22 – $140.40

Typical copayment $17.71 (range $4.55 – $35.10)

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 17

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

VENETTA DIALE BELOWE MWENGELLA NP-C

Nurse Practitioner (Family)