Individual
CHUL JIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
160 CONVENT AVE, NEW YORK, NY 10031-9101
(212) 650-7745
Mailing address
301 73RD ST APT 3, BROOKLYN, NY 11209-2545
(646) 331-0624
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
028269-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
11/02/2019
Last updated
10/23/2022
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