Provider Demographics
NPI:1710293675
Name:PARK, NAOMI (MD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TRIUMPH BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6475
Mailing Address - Country:US
Mailing Address - Phone:801-821-2781
Mailing Address - Fax:
Practice Address - Street 1:2355 E CAMELBACK RD STE 625
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3458
Practice Address - Country:US
Practice Address - Phone:480-626-7584
Practice Address - Fax:480-210-0230
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1707462084P0800X
AZ486872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry