DR. HENNA SHIM PARK DO
NPI 1962039941
Pediatrics in San Diego, CA
About Dr. Henna Shim Park Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. HENNA SHIM PARK DO (NPI 1962039941) is an individual pediatrics provider in San Diego, California, licensed in California (20A21399) and active in the NPI registry since March 2020. She is enrolled in Medicare PECOS and maintains a secondary practice location in Carlsbad.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Henna Shim Park Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Henna Park reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
La Jolla, CA 92037
- Reassigned Medicare billing, California enrollment
- 1,598 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92130 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.
SAN DIEGO, CA 92130
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 Henna Park's NPI number?
The NPI number for Henna Park is 1962039941. It was assigned to this individual provider in the NPPES registry on March 27, 2020.
Where is Henna Park located?
Henna Park practices at 3811 Valley Centre Dr, San Diego, CA 92130. The listed phone number is (858) 554-7272.
What is Henna Park's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Henna Park enrolled in Medicare?
Yes. Henna Park is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Henna Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Henna Park reassigns Medicare benefits to Scripps Health (La Jolla, 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 Henna 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 Henna Park was last updated on September 23, 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.
# Dr. Henna Shim Park, DO · NPI 1962039941
Pediatrics physician in San Diego, California. Individual provider, active in the CMS NPPES registry since March 27, 2020.
## Identity
- **NPI:** 1962039941 (Entity type: Individual)
- **Enumerated:** March 27, 2020
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 20A21399 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3811 VALLEY CENTRE DR, San Diego, CA 92130-2332
- **Phone:** (858) 554-7272
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Scripps Health (NPI 1275899072, La Jolla, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 23, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1962039941) · Data from the CMS NPPES public registry.