JUN SANG PARK
NPI 1770210254
Dentist - Periodontics in Los Angeles, CA
About Jun Sang Park NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JUN SANG PARK (NPI 1770210254) is an individual periodontics provider in Los Angeles, California, licensed in California (DDS107513) and active in the NPI registry since August 2022. He has opted out of Medicare through December 5, 2027 and remains eligible to order and refer.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Jun Sang Park has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 5, 2025 through December 5, 2027.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90020 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
LOS ANGELES, CA 90020
LOS ANGELES, CA 90020
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 Jun Sang Park's NPI number?
The NPI number for Jun Sang Park is 1770210254. It was assigned to this individual provider in the NPPES registry on August 4, 2022.
Where is Jun Sang Park located?
Jun Sang Park practices at 4220 W 3rd St, Los Angeles, CA 90020. The listed phone number is (209) 518-2095.
What is Jun Sang Park's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.
Is Jun Sang Park enrolled in Medicare?
No. Jun Sang Park has opted out of Medicare through December 5, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.
What insurance does Jun Sang Park accept?
Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Jun Sang 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 Jun Sang Park was last updated on August 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Jun Sang Park · NPI 1770210254
Periodontics provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since August 4, 2022.
## Identity
- **NPI:** 1770210254 (Entity type: Individual)
- **Enumerated:** August 4, 2022
- **Primary specialty:** Dentist - Periodontics · taxonomy 1223P0300X
- **State license:** DDS107513 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4220 W 3RD ST, Los Angeles, CA 90020-3450
- **Phone:** (209) 518-2095
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through December 5, 2027); services are provided under private contract
## Record status
- **NPPES last updated:** August 4, 2022
- **Other identifiers:** Other DDS107513 (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1770210254) · Data from the CMS NPPES public registry.