Individual provider Active NPI

Dai Park, M.D.

  • Allergy & Immunology Physician
  • Modesto, CA
National Provider Identifier
1376744896
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
A101619 Issued in CA
Practice address
600 Coffee Rd
Modesto, CA 95355-4201
Phone
(209) 521-6097
NPI assigned
May 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 45278 TN
Internal Medicine Physician 207R00000X A101619 CA
Allergy & Immunology Physician 207K00000X A101619 CA Primary

Addresses

Primary practice location

600 Coffee Rd
Modesto, CA 95355-4201

Mailing address

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 521-6097

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820000301 CA Practitioner - Allergy/ImmunologyPractitioner - Internal Medicine 2163563875 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Allergy/ImmunologyAlso: Internal Medicine
Education
University of Texas Southwestern Medical School at Dallas, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

123 S San Mateo Dr
San Mateo, CA 94401-3804
Phone (650) 343-4200

1720 El Camino Real
Burlingame, CA 94010-3225

3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A101619CAMDAllergy & Immunology Physician
45278TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baz Allergy, Asthma & Sinus Center, Inc. CurrentSince Jun 6, 2017 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Feb 7, 2022 Accepting new patients
Baz Allergy, Asthma & Sinus Center CurrentSince Jun 6, 2017 Accepting new patients
Baz Allergy, Asthma & Sinus Center, Inc. Current Accepting new patients
Permanente Medical Group Inc Internal Medicine CurrentSince Jan 2, 2018 Accepting new patients
Permanente Medical Group, Inc CurrentSince Jan 2, 2018 Accepting new patients
Permanente Medical Group Inc Internal Medicine Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation Internal Medicine CurrentSince Feb 7, 2022 Accepting new patients
Sutter Gould Medical Foundation Internal Medicine Past Accepting new patients
Sutter East Bay Medical Foundation Internal Medicine Past Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients

Locations (25 of 36)

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

4000 Dublin Blvd
Dublin, CA 94568
Phone (510) 498-2374

4000 Dublin Blvd
Fl 2
Dublin, CA 94568

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

7471 N Fresno St
Fresno, CA 93720
Phone (559) 436-4500

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

1415 Badger Flat Rd
Ste A
Los Banos, CA 93635
Phone (209) 710-8684

4601 Dale Rd
Modesto, CA 95356
Phone (209) 557-1000

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

1923 Coffee Rd
Ste 12C
Modesto, CA 95355
Phone (209) 409-8454

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

Interoperability endpoints

  • Direct secure messaging: dpark126731@hisp.ehr.sutterhealth.org

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1376744896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-521-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-521-6097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "45278",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A101619",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "CA",
            "license": "A101619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4601 Dale Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953569718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.