Healthcare Provider Details

I. General information

NPI: 1013903491
Provider Name (Legal Business Name): CHINYOUNG PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 WAUKEGAN RD SUITE 200
MORTON GROVE IL
60053-2127
US

IV. Provider business mailing address

900 RAND RD SUITE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 847-375-3000
  • Fax:
Mailing address:
  • Phone: 847-375-3000
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0036-082295
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: