MEDICARE: PAUL J. PARK PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1518852755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL J. PARK PLLC

Provider Business Mailing Address
First Line	:	620 HUNTER FLAT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 S FORT APACHE RD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7667
Country	:	US
Telephone Number	:	424-402-2933
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. PAUL JAHNG PARK
Credential	:	DDS
Telephone Number	:	424-402-2933

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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