SOOJEONG KIM PARK (MS, RD, CDE) – Registered Dietitian, NPI 1902036148
Registered Dietitian
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
115 REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL in GA
Provider Addresses for SOOJEONG KIM PARK (MS, RD, CDE)
2698 KNOX CREEK RD
DULUTH, GA 300972630
Phone: (408) 482-1110
Type: Mailing
550 PEACHTREE ST NE
ATLANTA, GA 303082212
Phone: (404) 778-4991
Type: Location
1456;1458;1460;1462;1464;1466;1468;1470;1472;1474, Birchmeadow Lane, Woodland Meadow, Wayne, San Jose, Santa Clara County, California, 95131, United States
SAN JOSE, CA 951313739
Phone: (408) 456-0241
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-09-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210915001054 | I | Registered Dietitian Or Nutrition Professional | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes | 135 | 16 | $0 |
| 97802 | Therapy procedure for nutrition management, each 15 minutes | 67 | 22 | $0 |
| 97803 | Therapy procedure reassessment for nutrition management, each 15 minutes | 53 | 15 | $0 |
Insurance plans in this area (ZIP 30097)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | CA | |
| Internal Medicine | GA | |
| Physician Assistant | FL | |
| Interventional Radiology, Diagnostic Radiology | KY | |
| Anesthesiology Assistant | GA | |
| - | CA | |
| D E R M A T O L O G Y | GA | |
| Interventional Radiology, Diagnostic Radiology | NC | |
| Physician Assistant | GA | |
| - | GA |
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