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DR. JAKE SANGCHUL PARK D.D.S
NPI 1891073680
Dentist - Periodontics in Boston, MA

Active since July 27, 2011PECOS Enrolled
1 KNEELAND ST, TUFTS DENTAL. DEPARTMENT OF PERIODONTOLOGY, BOSTON, MA 02111(617) 292-4366 Get Directions Write a Review

NPPES record last updated: August 7, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Jake Sangchul Park D.d.s NPPES

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

DR. JAKE SANGCHUL PARK D.D.S (NPI 1891073680) is an individual periodontics provider in Boston, Massachusetts, licensed in Massachusetts (DN1855799) and active in the NPI registry since July 2011. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1891073680
Entity TypeIndividualMale
Primary Taxonomy1223P0300X
Provider Legal NameDR. JAKE SANGCHUL PARKCredential: D.D.S
Location Address1 KNEELAND ST, TUFTS DENTAL. DEPARTMENT OF PERIODONTOLOGYBoston, MA 02111
Mailing Address1 Kneeland St, Tufts Dental. Department Of PeriodontologyBoston, MA 02111-1527 · (617) 292-4366
Phone(617) 292-4366
Sole ProprietorYes
Enumeration DateJuly 27, 2011
Last NPPES UpdateAugust 7, 2018
✔ NPI 1891073680 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in MA · DN1855799
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
1 KNEELAND ST, Boston, MA 02111
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Sheld, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana 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)

Dr. Jake Sangchul Park D.d.s 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 02111 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
$97.64 typical visit price
range $63.72 – $189.86
Typical copayment $24.41 (range $15.93 – $47.46)
Most-billed visit code 99203
Established Patient
$78.84 typical visit price
range $21.07 – $155.29
Typical copayment $19.71 (range $5.26 – $38.82)
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.

DR. ROCIO SAAVEDRA DDS
Dentist
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6971
EIRRION DOMINIQUE TIMMONS
Student in an Organized Health Care Education/Training Program
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6828
MICHELLE IRENE VALDES
Student in an Organized Health Care Education/Training Program
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6828
NORAH ALAJAJI
Dental Assistant
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6591
DR. ANUJA CHUMBLE PANDA DMD
Dentist (General Practice)
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-2163
GRACE WANG
Student in an Organized Health Care Education/Training Program
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6828
YEHAN KIM
Student in an Organized Health Care Education/Training Program
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6828
GRACE DAVIS
Student in an Organized Health Care Education/Training Program
1 KNEELAND ST
BOSTON, MA 02111
Suffolk County (617) 636-6828

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 Jake Park's NPI number?

The NPI number for Jake Park is 1891073680. It was assigned to this individual provider in the NPPES registry on July 27, 2011.

Where is Jake Park located?

Jake Park practices at 1 Kneeland St Tufts Dental. Department Of Periodontology, Boston, MA 02111. The listed phone number is (617) 292-4366.

What is Jake Park's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Jake Park enrolled in Medicare?

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

What insurance does Jake Park accept?

Health plans from Anthem Blue Cross and Blue Sheld, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 1 other insurer list Jake 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 Jake Park was last updated on August 7, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.