NPIMap

Individual provider Active NPI

Brian Youngjae Park, D.O.

  • Family Medicine Physician
  • Encinitas, CA
National Provider Identifier
1326339839
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A20862 Issued in CA
Practice address
326 Santa Fe Dr
Encinitas, CA 92024-5156
Phone
(760) 633-7260
NPI assigned
May 2, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Military Health Care ProviderGroup: 193400000X SINGLE SPECIALTY GROUP 171000000X
Family Medicine Physician 207Q00000X 60462-21 WI
Family Medicine Physician 207Q00000X 20A20862 CA Primary

Addresses

Primary practice location

326 Santa Fe Dr
Encinitas, CA 92024-5156

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (760) 633-7260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230619000646 CA Practitioner - Family Practice 3678931953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

326 Santa Fe Dr
FL 3
Encinitas, CA 92024-5156
Phone (760) 633-6067

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A20862CAMDFamily Medicine Physician
60462-21WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Single Specialty Current Accepting new patients
Scripps Health Single Specialty CurrentSince Jun 26, 2023 Accepting new patients
Scripps Health CurrentSince Jun 26, 2023 Accepting new patients
Scripps Health Single Specialty Current Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

326 Santa Fe Dr
Fl 3
Encinitas, CA 92024
Phone (760) 633-6067

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1326339839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10790 RANCHO BERNARDO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921275705",
            "telephone_number": "760-633-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 SANTA FE DR",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920245156",
            "telephone_number": "760-633-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BRIAN",
        "middle_name": "YOUNGJAE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-02",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "60462-21",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A20862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encinitas, CA

Sources for this page

Verify at the official NPI Registry.