Individual
CHANJUN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4741
(401) 444-4445
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4741
(401) 444-4445
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
LP06282
RI
Other
Enumeration date
05/06/2024
Last updated
05/29/2024
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