KIWON PARK FNP-C
NPI 1346124864
Nurse Practitioner in Fullerton, CA

Q: What is Kiwon Park's NPI number?

The NPI number for Kiwon Park is 1346124864. It was assigned to this individual provider in the NPPES registry on August 5, 2025.

Q: What is Kiwon Park's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kiwon Park was last updated on August 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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 August 05, 2025PECOS Enrolled

111 W VALENCIA DR, FULLERTON, CA 92832(858) 717-2545 Get Directions Write a Review

NPPES record last updated: August 7, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Kiwon Park Fnp-c NPPES

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

KIWON PARK FNP-C (NPI 1346124864) is an individual nurse practitioner in Fullerton, California, licensed in California (95036452) and active in the NPI registry since August 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1346124864

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameKIWON PARKCredential: FNP-C

Location Address111 W VALENCIA DRFullerton, CA 92832-2317

Mailing Address111 W Valencia DrFullerton, CA 92832-2317 · (858) 717-2545

Phone(858) 717-2545

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateAugust 5, 2025

Last NPPES UpdateAugust 7, 2025

NPPES CertifiedAugust 7, 2025

✔ NPI 1346124864 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in CA · 95036452

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

111 W VALENCIA DR, Fullerton, CA 92832

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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)

Kiwon Park Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6103397161

PECOS Enrollment IDI20260610001469

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 92832 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.

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 Kiwon Park's NPI number?

The NPI number for Kiwon Park is 1346124864. It was assigned to this individual provider in the NPPES registry on August 5, 2025.

Where is Kiwon Park located?

Kiwon Park practices at 111 W Valencia Dr, Fullerton, CA 92832. The listed phone number is (858) 717-2545.

What is Kiwon Park's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Kiwon Park enrolled in Medicare?

Yes. Kiwon Park is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kiwon Park was last updated on August 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.