Sung Jin Park, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

60815 Issued in CA

Practice address

1000 Fairview Rd
Hollister, CA 95023-9644

Phone

(714) 545-5550

Fax

(949) 609-0374

NPI assigned

Apr 9, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Flatow Medical Corporation ApcGroup PAC ID 6507273059, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flatow Medical Corporation Apc

  dba Pacific Mind Health

  • Psychiatry Physician
  • Torrance, CA
  • NPI 1659970333
  Medicare reassignment Care Compare group
• Hoag Hospital

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1689864365
  NPD (past)
• Thomas and Flatow Medical Corporation

  dba Pacific Mind Health

  • Psychiatry Physician
  • Long Beach, CA
  • NPI 1609377902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1093457194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 BARRANCA PKWY # 1018",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926064940",
            "telephone_number": "949-939-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 FAIRVIEW RD",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950239644",
            "telephone_number": "714-545-5550",
            "fax_number": "949-609-0374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6850 Ontario Rd",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "934058000",
            "country_code": "US",
            "telephone_number": "714-545-5550",
            "fax_number": "949-609-0374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUNG",
        "middle_name": "JIN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-09",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• P and B Sales
• Pacific Clinics
• Kristine Amber Padilla
• Gianni Paredez
• Isla Paredez
• Pathak-Paudel Dental PC
• Ichhya Pathak-Paudel, DMD
• Danielle Patino
• Paul J Percival M D Medical Corporation (Hollister Family Medicine)
• Catherine Pavoni

• Physician Assistant in Hollister, CA
• Providers in Hollister, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.