Provider Demographics
NPI:1881983468
Name:PARK, BORAM KIM (MD)
Entity type:Individual
Prefix:DR
First Name:BORAM
Middle Name:KIM
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BORAM
Other - Middle Name:RACHEL
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3607 OAK LAWN AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4743
Mailing Address - Country:US
Mailing Address - Phone:214-375-6262
Mailing Address - Fax:214-375-6266
Practice Address - Street 1:3607 OAK LAWN AVE STE 270
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4743
Practice Address - Country:US
Practice Address - Phone:214-375-6262
Practice Address - Fax:214-375-6266
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine