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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.

GEONWOONG PARK DDS
NPI 1659109163
Dentist in Rockford, IL

Active since July 25, 2024PECOS Enrolled
1200 W STATE ST, ROCKFORD, IL 61102(815) 490-1600(815) 490-1881 Get Directions Write a Review

NPPES record last updated: November 5, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Nov 5, 2026, Aug 14, 2025, Jul 25, 2024 (3 updates tracked since 2024).

About Geonwoong Park Dds NPPES

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

GEONWOONG PARK DDS (NPI 1659109163) is an individual dentist in Rockford, Illinois, licensed in Illinois (019035398) and active in the NPI registry since July 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1659109163
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameGEONWOONG PARKCredential: DDS
Location Address1200 W STATE STRockford, IL 61102-2112
Mailing Address1200 W State StRockford, IL 61102-2112 · (815) 490-1600 · Fax (815) 490-1881
Phone(815) 490-1600
Fax(815) 490-1881
Sole ProprietorNo
Enumeration DateJuly 25, 2024
Last NPPES UpdateNovember 5, 20263 updates tracked since enumeration
NPPES CertifiedNovember 5, 2026
✔ NPI 1659109163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019035398
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.
1200 W STATE ST, Rockford, IL 61102
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Anthem Blue Cross and Blue Shield, BEST Life 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)

Geonwoong Park Dds 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 61102 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
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.

CARYN ANN RUZIC APRN
Nurse Practitioner (Family)
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
DR. JOHN WALL MD
Family Medicine
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
DR. ADEKOLA ABIOUDUN ASHAYE MD
Internal Medicine
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
DR. GARY PATRICK FERNANDO MD
Pediatrics
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
CRISTINA A DIVENTI LCSW
Social Worker (Clinical)
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
CORNITA CANNON M.D.
Obstetrics & Gynecology
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
LAURA D PEREZ CNM, APRN
Advanced Practice Midwife
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600
KERIN CUMMINS APN
Nurse Practitioner (Family)
1200 W STATE ST
ROCKFORD, IL 61102
Winnebago County (815) 490-1600

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 Geonwoong Park's NPI number?

The NPI number for Geonwoong Park is 1659109163. It was assigned to this individual provider in the NPPES registry on July 25, 2024.

Where is Geonwoong Park located?

Geonwoong Park practices at 1200 W State St, Rockford, IL 61102. The listed phone number is (815) 490-1600.

What is Geonwoong Park's specialty?

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

Is Geonwoong Park enrolled in Medicare?

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

What insurance does Geonwoong Park accept?

Health plans from Ambetter Health, Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 6 other insurers list Geonwoong 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 Geonwoong Park was last updated on November 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.