DR. JESSIE SEONG-YEON PARK PSYD
NPI 1376953257
Psychologist - Clinical in San Diego, CA
About Dr. Jessie Seong-yeon Park Psyd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JESSIE SEONG-YEON PARK PSYD (NPI 1376953257) is an individual clinical provider in San Diego, California, licensed in California (26248) and active in the NPI registry since May 2014. She is enrolled in Medicare PECOS and is a graduate of Other (2002).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Jessie Seong-yeon Park Psyd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jessie Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Diego, CA 92103
- Reassigned Medicare billing, California enrollment
- 220 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92103 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 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAN DIEGO, CA 92103
SAN DIEGO, CA 92103
SAN DIEGO, CA 92103
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 Jessie Park's NPI number?
The NPI number for Jessie Park is 1376953257. It was assigned to this individual provider in the NPPES registry on May 1, 2014.
Where is Jessie Park located?
Jessie Park practices at 200 W Arbor Dr, San Diego, CA 92103. The listed phone number is (800) 926-8273.
What is Jessie Park's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Jessie Park enrolled in Medicare?
Yes. Jessie Park is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jessie Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jessie Park reassigns Medicare benefits to Regents Of The University Of California (San Diego, 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 Jessie 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 Jessie Park was last updated on August 22, 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.
# Dr. Jessie Seong-Yeon Park, PSYD · NPI 1376953257
Clinical provider in San Diego, California. Individual provider, active in the CMS NPPES registry since May 1, 2014.
## Identity
- **NPI:** 1376953257 (Entity type: Individual)
- **Enumerated:** May 1, 2014
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 26248 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 200 W ARBOR DR, San Diego, CA 92103-9000
- **Phone:** (800) 926-8273
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Regents Of The University Of California (NPI 1508968967, San Diego, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2002
## Record status
- **NPPES last updated:** August 22, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1376953257) · Data from the CMS NPPES public registry.