MEDICARE: BYUNG RYANG PARK MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	K6211	TX
2	207RI0011X	Interventional Cardiology Physician	K6211	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110176958	OTHER	TX	RAILROAD MEDICARE LOC 11
4	P00044325	OTHER	TX	RAILROAD MEDICARE LOC 99

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1306846787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYUNG RYANG PARK MD

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN STE 220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4425
Country	:	US
Telephone Number	:	214-345-8692
Fax Number	:

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN STE 220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4425
Country	:	US
Telephone Number	:	214-345-8692
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/03/2021

8230 WALNUT HILL LN STE 714
DALLAS, TX
75231-4425

Practice Phone: 214-696-4696
Practice Fax: 214-696-4699