Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Sungjin Park

Individual provider Physician Assistant · NPI 1730546078

Sungjin Park is a Physician Assistant in Dallas, Texas. Qualified in 2015, 11 years ago. Practices with Lisbon Tech LLC, a 2-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
11
Licensed in
TX
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

10400 N Central Expy
Dallas, TX 75231-2297
Phone: (972) 884-4400
Fax: (972) 884-4401
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 729 W Bedford Euless Rd, Hurst, TX 76053-3939 — (817) 288-0084

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA10351 (TX)
Physician Assistant Taxonomy 363A00000X · Licence PATMP596408 (TX)

Record details

NPI number1730546078
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 18, 2016
Last updated in NPPESJanuary 15, 2019
Mailing address10400 N Central Expy, Dallas, TX 75231-2297

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Lisbon Tech Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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