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General NPI Number Information
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NPI Number | 1720283153
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Entity Type | Individual
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Provider Name | CHAN W. PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2007
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 1 JARRETT WHITE ROAD DEPARTMENT OF SURGERY - 2 OCEANSIDE
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City | HONOLULU
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State | HI
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Zip | 96859
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Country | US
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Telephone | 808-433-1730
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 ALA MOANA BLVD APT 913
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City | HONOLULU
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State | HI
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Zip | 96815-1464
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Country | US
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Telephone | 808-433-1730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD-16643
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License Number State | HI
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