MEDICARE: DR. MIN S. CHUNG-PARK RN, NP, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	275715	CA

General Provider Information

NPI Number	:	1578557260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIN S. CHUNG-PARK RN, NP, PHD

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:	NAVAL MEDICAL CENTER
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-5000
Country	:	US
Telephone Number	:	619-524-6185
Fax Number	:	619-524-6191

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR
Second Line	:	NAVAL MEDICAL CENTER
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-5000
Country	:	US
Telephone Number	:	619-524-6185
Fax Number	:	619-524-6191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/23/2014

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