| Boram Park, M.d., Pllc | |
|
3607 Oak Lawn Ave Ste 270 Dallas TX 75219-4743 | |
| (214) 375-6262 | |
| (214) 375-6266 |
| Full Name | Boram Park, M.d., Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3607 Oak Lawn Ave Ste 270, Dallas, Texas |
| Authorized Official Name and Position | Boram Kim Park (OWNER) |
| Authorized Official Contact | 2143756262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boram Park, M.d., Pllc 3607 Oak Lawn Ave Ste 270 Dallas TX 75219-4743 Ph: (214) 375-6262 | Boram Park, M.d., Pllc 3607 Oak Lawn Ave Ste 270 Dallas TX 75219-4743 Ph: (214) 375-6262 |
| NPI Number | 1821616566 |
|---|---|
| Provider Enumeration Date | 07/09/2020 |
| Last Update Date | 07/09/2020 |
| Medicare PECOS PAC ID | 3577976562 |
|---|---|
| Medicare Enrollment ID | O20210112002548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821616566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Boram K Park |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881983468 PECOS PAC ID: 8820238009 Enrollment ID: I20151113000679 |
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