Individual
CHARLES KANG KYU PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
560 W 168TH ST, NEW YORK, NY 10032-3917
(212) 305-4318
Mailing address
560 W 168TH ST, NEW YORK, NY 10032-3917
(212) 305-4318
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
780948-01
NY
367500000X
Certified Registered Nurse Anesthetist
780948
NY
Other
Enumeration date
07/17/2023
Last updated
03/12/2026
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