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

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: November 01, 2026.

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, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignment

Medicare enrollment records show Kiwon Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Los Angeles Hematology-Oncology Medical Group
23 mi
Specialist
1245 WILSHIRE BLVD STE 303
Los Angeles, CA 90017
  • Reassigned Medicare billing, California enrollment
  • 59 clinicians in this Medicare group
NPI 1457409674 (213) 977-1214

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 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.

Which organization bills Medicare for Kiwon Park's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kiwon Park reassigns Medicare benefits to Los Angeles Hematology-Oncology Medical Group (Los Angeles, CA). 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 Kiwon 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 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 14 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.