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JOOYOELPARK DDS INC
NPI 1609215284
Dentist in San Pedro, CA

Active since June 18, 2013
204 N PACIFIC AVE, SAN PEDRO, CA 90731(310) 832-8800(310) 832-8801 Get Directions Write a Review

NPPES record last updated: June 18, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jooyoelpark Dds Inc NPPES

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

JOOYOELPARK DDS INC (NPI 1609215284) is a healthcare organization registered as a dentist in San Pedro, California and active in the NPI registry since June 2013. The organization lists Jooyoel Park, Ceo, as its authorized official.

NPPES Registry Identity

NPI1609215284
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameJOOYOELPARK DDS INC
Location Address204 N PACIFIC AVESan Pedro, CA 90731-2016
Mailing Address204 N Pacific AveSan Pedro, CA 90731-2016 · (310) 832-8800 · Fax (310) 832-8801
Phone(310) 832-8800
Fax(310) 832-8801
Organization SubpartNo
Authorized OfficialJooyoel ParkCeo · (310) 832-8800
Enumeration DateJune 18, 2013
✔ NPI 1609215284 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in CA · 55530
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
204 N PACIFIC AVE, San Pedro, CA 90731
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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)

Jooyoelpark Dds Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

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 IDO20140718001043Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
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 Jooyoelpark DDS Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jooyoel Park
Oral Surgery
NPI 1306979638
69160 RAMON RD. SUITE #100
Cathedral City, CA 92234
(760) 969-5469
✔ PECOS106 mi

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 Jooyoelpark Dds Inc's NPI number?

The NPI number for Jooyoelpark Dds Inc is 1609215284. It was assigned to this organization in the NPPES registry on June 18, 2013.

Where is Jooyoelpark Dds Inc located?

Jooyoelpark Dds Inc is located at 204 N Pacific Ave, San Pedro, CA 90731. The listed phone number is (310) 832-8800.

What is Jooyoelpark Dds Inc's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Jooyoelpark Dds Inc enrolled in Medicare?

Yes. Jooyoelpark Dds Inc is registered in the Medicare PECOS enrollment system.

When is Jooyoelpark Dds Inc'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 November 30, 2026. 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 Jooyoelpark Dds Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Oral Surgery) reassigns their Medicare billing to Jooyoelpark Dds Inc. 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 Jooyoelpark Dds Inc was last updated on June 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.