Healthcare Provider Details

I. General information

NPI: 1316872963
Provider Name (Legal Business Name): SEHOON PARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 SW 1ST AVE STE 103
CANBY OR
97013-3863
US

IV. Provider business mailing address

7192 SW SCHOLLS FERRY RD APT 3
BEAVERTON OR
97008-4076
US

V. Phone/Fax

Practice location:
  • Phone: 971-259-6948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12381
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: