Individual
CHAN HOON PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
905 VICTORY HWY, SLATERSVILLE, RI 02876
(401) 762-2728
(401) 762-0473
Mailing address
905 VICTORY HWY, PO BOX 177, SLATERSVILLE, RI 02876
(401) 762-2728
(401) 762-0473
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD 5083
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001727
BLUE CHIP
RI
01
—
0100118
UNITED HEALTHCARE
PR
01
—
1260-1
BLUE CROSS BLUE SHIELD
RI
05
—
9001260
—
RI
Enumeration date
05/15/2007
Last updated
02/26/2008
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