Healthcare Provider Details

I. General information

NPI: 1710293675
Provider Name (Legal Business Name): NAOMI PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 E CAMELBACK RD STE 625
PHOENIX AZ
85016-3458
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax: 480-210-0230
Mailing address:
  • Phone: 801-821-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC170746
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number48687
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: