JAECHAN PARK D.D.S.
NPI 1275666315
Dentist - General Practice in Gardena, CA
About Jaechan Park D.d.s. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JAECHAN PARK D.D.S. (NPI 1275666315) is an individual general practice provider in Gardena, California, licensed in California (49972) and active in the NPI registry since March 2007. He is enrolled in Medicare PECOS and maintains a secondary practice location in Anchorage.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 5
Accepted 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)
Jaechan Park D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
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.
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.
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 Jaechan Park's NPI number?
The NPI number for Jaechan Park is 1275666315. It was assigned to this individual provider in the NPPES registry on March 14, 2007.
Where is Jaechan Park located?
Jaechan Park practices at 15201 S Western Ave, Gardena, CA 90249. The listed phone number is (310) 400-7705.
What is Jaechan Park's specialty?
The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.
Is Jaechan Park enrolled in Medicare?
Yes. Jaechan Park is registered in the Medicare PECOS enrollment system.
What insurance does Jaechan Park accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Humana list Jaechan 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 Jaechan Park was last updated on March 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Jaechan Park, D.D.S. · NPI 1275666315
General Practice provider in Gardena, California. Individual provider, active in the CMS NPPES registry since March 14, 2007.
## Identity
- **NPI:** 1275666315 (Entity type: Individual)
- **Enumerated:** March 14, 2007
- **Primary specialty:** Dentist - General Practice · taxonomy 1223G0001X
- **State license:** 49972 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 15201 S WESTERN AVE, Gardena, CA 90249-4314
- **Phone:** (310) 400-7705
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
## Record status
- **NPPES last updated:** March 13, 2023
- **Other identifiers:** Other 1687022 (PA); Other G92988-01 (CA); Medicaid 1581480 (AK); and 2 more
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Source: [NPI Profile](https://npiprofile.com/npi/1275666315) · Data from the CMS NPPES public registry.