Individual
DR. CHANWANG PARK
Active
Individual
DR. CHANWANG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01073853A
IN
207L00000X
Anesthesiology Physician
Primary
C170507
CA
390200000X
Student in an Organized Health Care Education/Training Program
11015365A
IN
Other
Enumeration date
06/09/2010
Last updated
12/07/2022
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