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NPI Code Detail

MEDICARE: CHANHI PARK M.D.

MEDICARE:   CHANHI  PARK  M.D.
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
12085R0202XDiagnostic Radiology PhysicianME66655FL
22085R0202XDiagnostic Radiology Physician0101231753VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
125527OTHERFLBC BS OF FLORIDA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881677854
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANHI PARK M.D.
Provider Business Mailing Address
First Line : 2602 BUFORD RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-3422
Country : US
Telephone Number : 804-272-8806
Fax Number : 804-272-2909
Provider Business Practice Location Address
First Line : 2602 BUFORD RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-3422
Country : US
Telephone Number : 804-272-8806
Fax Number : 804-272-2909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 03/17/2018

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Directions to “ CHANHI PARK M.D.” Practice Location

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