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1205916269 NPI number — DENNIS CHAI SUN PARK I MA/MS, CADCIII, CDP

NPI Number: 1205916269
Health Care Provider/Practitioner: DENNIS CHAI SUN PARK I MA/MS, CADCIII, CDP

Information about “1205916269” NPI (DENNIS CHAI SUN PARK I MA/MS, CADCIII, CDP) exists in 1205916269 in HTML format HTML  |  1205916269 in plain Text format TXT  |  1205916269 in PDF (Portable Document Format) PDF  |  1205916269 in an XML format XML  formats.

NPI Number : 1205916269 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205916269",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PARK",
    "FirstName": "DENNIS",
    "MiddleName": "CHAI SUN",
    "NamePrefix": "MR.",
    "NameSuffix": "I",
    "Credential": "MA/MS, CADCIII, CDP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PARK",
    "OtherFirstName": "DENNIS",
    "OtherMiddleName": "CHAI SUN",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": "I",
    "OtherCredential": "MA/MS, CADCIII, CDP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1562",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODLAND",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98674-1500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-575-4818",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1230 7TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LONGVIEW",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98632-3166",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "180-025-7200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/16/2006",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "CP00005610",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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