Individual
CHAN W PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-1365
Mailing address
5100 BAYPORT LNDG, SUFFOLK, VA 23435-1358
(757) 576-5611
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101245598
VA
207P00000X
Emergency Medicine Physician
01054324A
IN
Other
Enumeration date
11/14/2005
Last updated
06/08/2009
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