JOHN JOONTAE PARK D.D.S.
NPI 1558718437
Dentist - General Practice in Portland, OR

Q: What is John Park's NPI number?

The NPI number for John Park is 1558718437. It was assigned to this individual provider in the NPPES registry on May 19, 2016.

Q: What is John Park's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for John Park was last updated on October 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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 May 19, 2016PECOS Enrolled

2100 NE BROADWAY ST STE 205, PORTLAND, OR 97232(503) 284-2893(503) 287-2016 Get Directions Write a Review

NPPES record last updated: October 21, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jan 19, 2021, May 19, 2016 (2 updates tracked since 2016).

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About John Joontae Park D.d.s. NPPES

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

JOHN JOONTAE PARK D.D.S. (NPI 1558718437) is an individual general practice provider in Portland, Oregon, licensed in Oregon (D10627) and active in the NPI registry since May 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1558718437

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameJOHN JOONTAE PARKCredential: D.D.S.

Location Address2100 NE BROADWAY ST STE 205Portland, OR 97232-1500

Mailing Address2100 Ne Broadway St Ste 205Portland, OR 97232-1500 · (503) 284-2893 · Fax (503) 287-2016

Phone(503) 284-2893

Fax(503) 287-2016

Sole ProprietorNo

Enumeration DateMay 19, 2016

Last NPPES UpdateOctober 21, 20242 updates tracked since enumeration

NPPES CertifiedOctober 21, 2024

✔ NPI 1558718437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in OR · D10627

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

2100 NE BROADWAY ST STE 205, Portland, OR 97232

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

John Joontae Park D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 97232 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

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$73.28 typical visit price

range $19.32 – $144.79

Typical copayment $18.32 (range $4.83 – $36.19)

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.

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 John Park's NPI number?

The NPI number for John Park is 1558718437. It was assigned to this individual provider in the NPPES registry on May 19, 2016.

Where is John Park located?

John Park practices at 2100 NE Broadway St Ste 205, Portland, OR 97232. The listed phone number is (503) 284-2893.

What is John Park's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is John Park enrolled in Medicare?

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

What insurance does John Park accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 10 other insurers list John Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for John Park was last updated on October 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.