MEDICARE: DR. NAOMI PARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C170746	CA
2	2084P0800X	Psychiatry Physician	48687	AZ

General Provider Information

NPI Number	:	1710293675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAOMI PARK MD

Provider Business Mailing Address
First Line	:	2355 E CAMELBACK RD STE 625
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 E CAMELBACK RD STE 625
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3458
Country	:	US
Telephone Number	:	480-626-7584
Fax Number	:	480-210-0230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2010
Last Update Date	:	04/06/2026

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Directions to “ DR. NAOMI PARK MD” Practice Location

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