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SANGDO PARK, M.D., A PROFESSIONAL CORPORATION
NPI 1346590098
Orthopaedic Surgery - Sports Medicine in Los Angeles, CA

Active since September 10, 2012
2105 BEVERLY BLVD, SUITE 223, LOS ANGELES, CA 90057(213) 989-0644 Get Directions Write a Review

NPPES record last updated: October 24, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Sangdo Park, M.d., A Professional Corporation NPPES

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

SANGDO PARK, M.D., A PROFESSIONAL CORPORATION (NPI 1346590098) is a healthcare organization registered as a sports medicine in Los Angeles, California and active in the NPI registry since September 2012. The organization lists Sangdo Park, Owner, as its authorized official.

NPPES Registry Identity

NPI1346590098
Entity TypeOrganization
Primary Taxonomy207XX0005X
Legal Business NameSANGDO PARK, M.D., A PROFESSIONAL CORPORATION
Location Address2105 BEVERLY BLVD, SUITE 223Los Angeles, CA 90057-2216
Mailing Address2105 Beverly Blvd, Suite 223Los Angeles, CA 90057-2216 · (213) 989-0644
Phone(213) 989-0644
Organization SubpartNo
Authorized OfficialSangdo ParkOwner · (213) 989-0644
Enumeration DateSeptember 10, 2012
Last NPPES UpdateOctober 24, 2012
✔ NPI 1346590098 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207XX0005X
License✔ Licensed in CA · A107642
Definition
An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.
2105 BEVERLY BLVD, Los Angeles, CA 90057
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sangdo Park, M.d., A Professional Corporation is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20121015000362Non-DME Part B · Clinic/Group PracticeDue dateFebruary 28, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Sangdo Park, M.D., A Professional Corporation, which bills Medicare for the services this clinician delivers.

Clinician (1)

Sangdo Park, MD
Orthopedic Surgery
NPI 1164582656
2105 BEVERLY BLVD SUITE 223
Los Angeles, CA 90057
(213) 989-0644
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Sangdo Park, M.D., A Professional Corporation's NPI number?

The NPI number for Sangdo Park, M.D., A Professional Corporation is 1346590098. It was assigned to this organization in the NPPES registry on September 10, 2012.

Where is Sangdo Park, M.D., A Professional Corporation located?

Sangdo Park, M.D., A Professional Corporation is located at 2105 Beverly Blvd Suite 223, Los Angeles, CA 90057. The listed phone number is (213) 989-0644.

What is Sangdo Park, M.D., A Professional Corporation's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Sports Medicine, with taxonomy code 207XX0005X.

Is Sangdo Park, M.D., A Professional Corporation enrolled in Medicare?

Yes. Sangdo Park, M.D., A Professional Corporation is registered in the Medicare PECOS enrollment system.

When is Sangdo Park, M.D., A Professional Corporation's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Sangdo Park, M.D., A Professional Corporation?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Orthopedic Surgery) reassigns their Medicare billing to Sangdo Park, M.D., A Professional Corporation. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Sangdo Park, M.D., A Professional Corporation was last updated on October 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.