Organization
CLINCH VALLEY NEPHROLOGY,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IN YOUNG PARK M.D. (C.E.O.)
(276) 964-4001
Entity
Organization
Contact information
Practice address
2951 FRONT ST, CLINCH VALLEY MEDICAL PLAZA, SUITE 1600, RICHLANDS, VA 24641-2055
(276) 964-4001
Mailing address
2951 FRONT ST, CLINCH VALLEY MEDICAL PLAZA, SUITE 1600, RICHLANDS, VA 24641-2055
(276) 964-4001
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101029175
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5879884
—
VA
Enumeration date
11/01/2007
Last updated
11/01/2007
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