Healthcare Provider Details

I. General information

NPI: 1609976547
Provider Name (Legal Business Name): THOMAS CHIN PARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CAPITOL AVE SUITE 402
SACRAMENTO CA
95816-6004
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9400
  • Fax: 916-262-9399
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG68104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: