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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.

DR. HENNA SHIM PARK DO
NPI 1962039941
Pediatrics in San Diego, CA

Active since March 27, 2020PECOS Enrolled
3811 VALLEY CENTRE DR, SAN DIEGO, CA 92130(858) 554-7272 Get Directions Write a Review

NPPES record last updated: September 23, 2026. Verified against the NPPES registry weekly; last sync: October 11, 2026.

Record update history: Sep 23, 2026, Jul 24, 2023, Mar 27, 2020 (3 updates tracked since 2020).

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

NPI1962039941
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameDR. HENNA SHIM PARKCredential: DO
Location Address3811 VALLEY CENTRE DRSan Diego, CA 92130-2332
Mailing Address10790 Rancho Bernardo RdSan Diego, CA 92127-5705 · (858) 554-7272
Phone(858) 554-7272
Sole ProprietorNo
Enumeration DateMarch 27, 2020
Last NPPES UpdateSeptember 23, 20263 updates tracked since enumeration
NPPES CertifiedSeptember 23, 2026
✔ NPI 1962039941 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · 20A21399
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
3811 VALLEY CENTRE DR, San Diego, CA 92130
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Secondary Practice Location 1

Location 12176 Salk Ave Ste 200Carlsbad, CA 92008-7346 · Phone (760) 827-7400

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. Henna Shim Park Do 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 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.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$108.42 typical visit price
range $20.62 – $151.42
Typical copayment $27.10 (range $5.15 – $37.85)
Most-billed visit code 99214
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.

TAYLOR LYNN ROMERO NP
Nurse Practitioner
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 764-9080
ANDREW SHIN LAI MD
Internal Medicine
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 455-9100
DR. TODD M. HITCHCOCK M.D.
Internal Medicine (Cardiovascular Disease)
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 764-3110
MANDY HILLMER FNP-C, CPNP
Nurse Practitioner (Pediatrics)
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 764-3040
DR. RIO DION DICKENS M.D.
Internal Medicine
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 764-3000
DR. HOLLY E. HAUSER M.D.
Family Medicine
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 764-9081
MITCH BIERMANN
Internal Medicine
3811 VALLEY CENTRE DR
SAN DIEGO, CA 92130
San Diego County (858) 764-3320
DR. ILIA J.L. CHRISTY M.D.
Internal Medicine
3811 VALLEY CENTRE DR, S99
SAN DIEGO, CA 92130
San Diego County (858) 764-3000

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.

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 21 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.