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NPI Code Detail

MEDICARE: CHUNG WHIY PARK

MEDICARE: CHUNG WHIY 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
11223G0001XGeneral Practice Dentistry38805TX

General Provider Information

NPI Number : 1942875125
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHUNG WHIY PARK
Provider Business Mailing Address
First Line : 5190 WESTERN CENTER BLVD
Second Line :
City : HALTOM CITY
State : TX
Zip : 76137-2144
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5190 WESTERN CENTER BLVD
Second Line :
City : HALTOM CITY
State : TX
Zip : 76137-2144
Country : US
Telephone Number : 817-656-1215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2021
Last Update Date : 03/25/2026

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Directions to “ CHUNG WHIY PARK ” Practice Location

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