Individual
DR. CHAN WOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
90 BERGEN STREET- SUITE 8100, DEPARTMENT OF OTOLARYNGOLOGY, DOC BUILDING, NEWARK, NJ 07103
(973) 972-4588
Mailing address
90 BERGEN STREET- SUITE 8100, DEPARTMENT OF OTOLARYNGOLOGY, DOC BUILDING, NEWARK, NJ 07103
(973) 972-4588
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
25MA09356100
NJ
207Y00000X
Otolaryngology Physician
MD60287386
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760644280
—
NY
Enumeration date
06/26/2008
Last updated
11/04/2013
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