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General NPI Number Information
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NPI Number | 1740683663
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Entity Type | Individual
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Provider Name | CHUN HYUNG PARK DC
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Gender | Male
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 21519 39TH AVE UNIT 3
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City | BAYSIDE
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State | NY
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Zip | 11361-2114
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Country | US
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Telephone | 201-994-6485
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Fax |
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Provider Business Mailing Address
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Address Line | 35 IRVING AVE
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-1435
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Country | US
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Telephone | 201-994-6485
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00718200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012779-1
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License Number State | NY
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