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NPI Code Detail

MEDICARE: DR. CHAN J. PARK MD

MEDICARE: DR. CHAN J. PARK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician5009SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306894332
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAN J. PARK MD
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-6585
Fax Number : 605-328-6512
Provider Business Practice Location Address
First Line : 20 S PLUM ST
Second Line :
City : VERMILLION
State : SD
Zip : 57069-3346
Country : US
Telephone Number : 605-624-9111
Fax Number : 605-624-6636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 09/12/2013

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