Provider Demographics
NPI:1356083000
Name:PARK, KALI S (CLD)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:S
Last Name:PARK
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HALF ST APT SUITE
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-9305
Mailing Address - Country:US
Mailing Address - Phone:214-674-7608
Mailing Address - Fax:
Practice Address - Street 1:207 HALF ST APT SUITE
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-9305
Practice Address - Country:US
Practice Address - Phone:214-674-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula