Shawn Seung Dae Park, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

01097499A Issued in IN

Practice address

101 Bodin Cir
Fairfield, CA 94535-1809

Phone

(707) 423-3792

Fax

(707) 423-3501

NPI assigned

Apr 3, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1538864335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3792",
            "fax_number": "707-423-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3792",
            "fax_number": "707-423-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SHAWN",
        "middle_name": "SEUNG DAE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "01097499A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paradise Valley Icf-DDH
• Melissa Pardi, MA, LMFT, LPCC
• Jolly Parikh, FNP
• Jeremy Robert Parish
• Tamaika Marie Parish
• Sung Wook Park, PHARMD
• Alison Alana Parker-Cole, D.D.S.
• Janette Berenice Parker, PA-C
• Kiari Parker
• Marikit B Parker, MD

• General Practice Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.