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NPI Code Detail

MEDICARE: KAEUN PARK DMD

MEDICARE: KAEUN PARK DMD
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
11223G0001XGeneral Practice Dentistry36615TX

General Provider Information

NPI Number : 1447863428
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAEUN PARK DMD
Provider Business Mailing Address
First Line : 3203 MULBERRY HILL RD APT 205
Second Line :
City : COPPELL
State : TX
Zip : 75019-5488
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 311 S BOWEN RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76013-1255
Country : US
Telephone Number : 817-339-6140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 08/28/2020

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Directions to “ KAEUN PARK DMD” Practice Location

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