SE Ha Park, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401416968 Issued in VA

Practice address

2133 Pepperrell St BLDG 3352
Jbsa Lackland, TX 78236-5313

Phone

(210) 292-6258

NPI assigned

May 24, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1821611989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 S SAINT MARYS ST UNIT 6502",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782051260",
            "telephone_number": "210-292-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 PEPPERRELL ST BLDG 3352",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SE HA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-24",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416968",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401416968",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Palmatier, MD
• Michael David Palmer, PA-C
• Cherilyn Mae Acorda Palochak, MD
• Michael William Pane, MD
• Kimberly Panther, DPT
• Allan S Parke, DDS
• Michael Ryan Parks, D.O.
• Eric R Parsons, PHARM. D.
• Martha Ellan Paul, CRNA
• Mary T Pawlak, MD

• Dentist in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.