Skip to content
NPISignal

Individual Healthcare Provider

Lily Park, D.O.

NPI Record: ActiveDermatology
NPI1124333455
Modesto, California

Provider's NPPES record last updated: August 8, 2024

Overview

Entity Type
Individual Healthcare Provider
NPI
1124333455
Primary Specialty
Dermatology
Practice Location
Modesto, California
Sole Proprietor
No

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 21, 2026, 7:17 PM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Dermatology

    Allopathic & Osteopathic Physicians

    Primary

    A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

    Taxonomy code 207N00000X
  • Internal Medicine

    Allopathic & Osteopathic Physicians

    A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

    Taxonomy code 207R00000X
  • Hospitalist

    Allopathic & Osteopathic Physicians

    Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

    Taxonomy code 208M00000X

Provider-Reported License Information

Dermatology (California)
12765
Internal Medicine (California)
20A12765
Internal Medicine (Michigan)
5101018747
Internal Medicine (Oregon)
DO184048
Hospitalist (California)
20A12765
License numbers are reported by the provider to NPPES and are not independently verified by NPISignal against any state licensing board. Confirm current license status directly with the issuing state board.

Practice Locations

Practice Location

600 Coffee Rd

Modesto, California 95355-4201

Phone: (209) 521-6097

Additional Practice Location

375 Se Norton Ln Ste C

Mcminnville, Oregon 97128-8484

Phone: (503) 362-8385

Fax: (503) 362-8435

Additional Practice Location

600 Coffee Rd

Modesto, California 95355-4201

Phone: (209) 521-6097

Additional Practice Location

1390 Waverly Dr Se

Albany, Oregon 97322-6958

Phone: (503) 362-8385

Record Information

Enumeration Date
August 11, 2010
Provider's NPPES Record Last Updated
August 8, 2024
Certification Date
August 8, 2024
NPISignal NPPES Dataset
August 2026

See Something Wrong?

Incorrect provider information

Everything on this page comes directly from the NPPES data CMS publishes. NPISignal cannot edit a provider's record — only the provider or organization can, directly through NPPES.

Update a record through NPPES

Something wrong with this page?

If NPISignal is displaying this data incorrectly — a formatting error, a broken link, a mismatch with the source file — let us know.

Report a display issue