Healthcare Provider Details

I. General information

NPI: 1417894411
Provider Name (Legal Business Name): KPARK ENDO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 E HIGHWAY 290 STE 206
AUSTIN TX
78723-1157
US

IV. Provider business mailing address

6633 E HIGHWAY 290 STE 206
AUSTIN TX
78723-1157
US

V. Phone/Fax

Practice location:
  • Phone: 512-649-3340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: KONY PARK
Title or Position: OWNER
Credential:
Phone: 512-649-3340