BENJAMIN CHUL PARK MD
NPI 1639861545
Student in an Organized Health Care Education/Training Program in Loma Linda, CA
About Benjamin Chul Park Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BENJAMIN CHUL PARK MD (NPI 1639861545) is an individual student in an organized health care education/training program in Loma Linda, California, licensed in Tennessee (72803) and active in the NPI registry since May 2023. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Benjamin Chul Park Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
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.
LOMA LINDA, CA 92350
LOMA LINDA, CA 92350
LOMA LINDA, CA 92350
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 Benjamin Park's NPI number?
The NPI number for Benjamin Park is 1639861545. It was assigned to this individual provider in the NPPES registry on May 22, 2023.
Where is Benjamin Park located?
Benjamin Park practices at 11234 Anderson St, Loma Linda, CA 92350. The listed phone number is (909) 558-6131.
What is Benjamin Park's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Benjamin Park enrolled in Medicare?
Yes. Benjamin Park is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Benjamin Park was last updated on June 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 42 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.
# Benjamin Chul Park, MD · NPI 1639861545
Student in an Organized Health Care Education/Training Program provider in Loma Linda, California. Individual provider, active in the CMS NPPES registry since May 22, 2023.
## Identity
- **NPI:** 1639861545 (Entity type: Individual)
- **Enumerated:** May 22, 2023
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **State license:** 72803 (Tennessee)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 11234 ANDERSON ST, Loma Linda, CA 92350-1716
- **Phone:** (909) 558-6131
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for durable medical equipment, power mobility devices
## Record status
- **NPPES last updated:** June 30, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1639861545) · Data from the CMS NPPES public registry.