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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. KENNETH J PARK DO
NPI 1457643215
Obstetrics & Gynecology in Redlands, CA

Active since May 11, 2011PECOS EnrolledAccepts Medicare Assignment
2 W FERN AVE, REDLANDS, CA 92373(909) 793-3311(805) 354-7102 Get Directions Write a Review

NPPES record last updated: July 31, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jul 31, 2026, Jan 4, 2026, Aug 21, 2018 and 2 more (5 updates tracked since 2015).

About Dr. Kenneth J Park Do NPPES

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

DR. KENNETH J PARK DO (NPI 1457643215) is an individual obstetrics & gynecology provider in Redlands, California, licensed in California (14077) and active in the NPI registry since May 2011. He is enrolled in Medicare PECOS and is a graduate of Other (2011).

NPPES Registry Identity

NPI1457643215
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameDR. KENNETH J PARKCredential: DO
Location Address2 W FERN AVERedlands, CA 92373
Mailing Address8077 Florence Ave Ste 112Downey, CA 90240-3894 · (562) 904-6031 · Fax (562) 904-6033
Phone(909) 793-3311
Fax(805) 354-7102
Sole ProprietorNo
Medical School CMSOtherGraduated 2011
Enumeration DateMay 11, 2011
Last NPPES UpdateJuly 31, 20265 updates tracked since enumeration
NPPES CertifiedJuly 31, 2026
✔ NPI 1457643215 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in CA · 14077
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
2 W FERN AVE, Redlands, CA 92373
Open in Google Maps ↗

Other Identifiers 1

OtherCB243726CA · Medicare Id

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kenneth J Park Do 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.

PECOS PAC ID5597074260
PECOS Enrollment IDI20151020001107
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 92373 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
$136.04 typical visit price
range $59.60 – $179.42
Typical copayment $34.01 (range $14.90 – $44.85)
Most-billed visit code 99204
Established Patient
$74.08 typical visit price
range $19.37 – $146.42
Typical copayment $18.52 (range $4.84 – $36.60)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

CYNTHIA L PACHECO AGACNP
Nurse Practitioner (Acute Care)
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 793-3311
MRS. LISA C ANDERSON N.P.
Nurse Practitioner
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 793-3311
MR. LUIS A SANCHEZ DO
Anesthesiology
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 793-3311
MADISON TUCKER ZAGURSKI PA-C
Physician Assistant (Medical)
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 792-2605
DR. BRADLEY BASINGER M.D.
Surgery
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 793-3311
JOHN W MORTENSEN M.D.
Radiology (Diagnostic Radiology)
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 793-3311
NARMISHA VIJAY PATEL M.D
Hospitalist
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 583-2741
DR. KEVIN JAN CHAN MD
Hospitalist
2 W FERN AVE
REDLANDS, CA 92373
San Bernardino County (909) 793-3311

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 Kenneth Park's NPI number?

The NPI number for Kenneth Park is 1457643215. It was assigned to this individual provider in the NPPES registry on May 11, 2011.

Where is Kenneth Park located?

Kenneth Park practices at 2 W Fern Ave, Redlands, CA 92373. The listed phone number is (909) 793-3311.

What is Kenneth Park's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Kenneth Park enrolled in Medicare?

Yes. Kenneth 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.

When was this NPI record last updated?

The NPPES record for Kenneth Park was last updated on July 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 35 days 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.