Ji Won Park, DMD in Marietta, GA - Medicare Dentist Provider

Ji Won Park, DMD is a medicare enrolled "Dentist - General Practice" provider in Marietta, Georgia. Her current practice location is 1605 Roberta Dr Sw, Marietta, Georgia. You can reach out to her office (for appointments etc.) via phone at (770) 419-3120.

Ji Won Park is licensed to practice in Georgia (license number DN015875) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1255984324.

Contact Information

	Ji Won Park, DMD
	1605 Roberta Dr Sw, Marietta, GA 30008-3855
	(770) 419-3120
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Ji Won Park
Gender	Female
Speciality	Dentist - General Practice
Location	1605 Roberta Dr Sw, Marietta, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1255984324
Provider Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019

Medicare PECOS Information:

PECOS PAC ID: 7911304985
Enrollment ID: I20210920000793

Medical Identifiers

Medical identifiers for Ji Won Park such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1255984324	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223G0001X	Dentist - General Practice	DN015875 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ji Won Park allows following entities to bill medicare on her behalf.

Entity Name	Good Samaritan Health Center Of Cobb
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1881923126 PECOS PAC ID: 7214970482 Enrollment ID: O20050608000595

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ji Won Park is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Ji Won Park, DMD 11 Perimeter Ctr E Apt 2304, Atlanta, GA 30346-1650 Ph: (404) 428-4851	Ji Won Park, DMD 1605 Roberta Dr Sw, Marietta, GA 30008-3855 Ph: (770) 419-3120

Reviews and Comments

Dentist in Marietta, GA

Dr. Melanie Anne Nadler, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 1075 Whitlock Ave Sw Ste C, Marietta, GA 30064 Phone: 770-422-5614
Dr. Thomas John Mazzuchelli, D.M.D. Dentist Medicare: Medicare Enrolled Practice Location: 58 Shawnee Ln, Marietta, GA 30067 Phone: 770-973-6520
David Chyan, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 4250 Roswell Rd Ste 110, Marietta, GA 30062 Phone: 770-509-5585
Dr. Barton L Mcghee Jr., D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 1000 Johnson Ferry Rd, Bldg H, Marietta, GA 30068 Phone: 770-977-0364 Fax: 678-819-6531
Dr. Ken H. Farrar, D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 3770 Due West Rd Nw, Suite 100, Marietta, GA 30064 Phone: 770-428-0283 Fax: 770-590-8658
Dr. Rina M Mehta, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 2500 Dallas Hwy Sw, Suite #401, Marietta, GA 30064 Phone: 770-428-4888 Fax: 770-428-4009
Lawrence P Husney, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 2663 Sandy Plains Road, Marietta, GA 30066 Phone: 770-977-0827 Fax: 770-973-6764

Ji Won Park, DMD - Medicare Dentist in Marietta, GA