MEDICARE: ELOISE HYUNJI PARK

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	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1235098963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELOISE HYUNJI PARK

Provider Business Mailing Address
First Line	:	3950 LUKE LN
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-1325
Country	:	US
Telephone Number	:	469-265-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 LUKE LN
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-1325
Country	:	US
Telephone Number	:	469-265-9620
Fax Number	:

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ ELOISE HYUNJI PARK ” Practice Location

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