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Individual
CHAN M PARK
Active
Individual
CHAN M PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101229138
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005372768
AETNA
—
05
—
010011019
—
VA
01
—
2108815
MAMSI
—
01
—
3506280
CIGNA
—
01
—
463669
ANTHEM, BCBS OF VIRGINIA
VA
01
—
A1738
MEDCOST PREFERRED
—
Enumeration date
08/23/2006
Last updated
07/08/2007
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