YONG JOON CALEB PARK
NPI 1720586902
Marriage & Family Therapist in Fullerton, CA
About Yong Joon Caleb Park NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
YONG JOON CALEB PARK (NPI 1720586902) is an individual marriage & family therapist in Fullerton, California, licensed in California (LMFT154900) and active in the NPI registry since January 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Yong Joon Caleb Park is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Yong Joon Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Jose, CA 95113
- Reassigned Medicare billing, California enrollment
- 3,139 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Yong Joon Park's NPI number?
The NPI number for Yong Joon Park is 1720586902. It was assigned to this individual provider in the NPPES registry on January 23, 2018.
Where is Yong Joon Park located?
Yong Joon Park practices at 211 Imperial Hwy Ste 102, Fullerton, CA 92835. The listed phone number is (562) 900-6193.
What is Yong Joon Park's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Yong Joon Park enrolled in Medicare?
Yes. Yong Joon Park is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Yong Joon Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Yong Joon Park reassigns Medicare benefits to Grow Healthcare Group PC (San Jose, CA). The 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 Yong Joon Park's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Yong Joon Park was last updated on March 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Yong Joon Caleb Park · NPI 1720586902
Marriage & Family Therapist provider in Fullerton, California. Individual provider, active in the CMS NPPES registry since January 23, 2018.
## Identity
- **NPI:** 1720586902 (Entity type: Individual)
- **Enumerated:** January 23, 2018
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **State license:** LMFT154900 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 211 IMPERIAL HWY STE 102, Fullerton, CA 92835-1047
- **Phone:** (562) 900-6193
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Grow Healthcare Group PC (NPI 1154994846, San Jose, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** March 6, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1720586902) · Data from the CMS NPPES public registry.