Individual
WAN YANG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-5067
(585) 922-2908
Mailing address
1425 PORTLAND AVE, BOX 242, ROCHESTER, NY 14621-3001
(585) 922-3697
(585) 922-5914
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
003100
NY
208M00000X
Hospitalist Physician
254792
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03013605
—
NY
Enumeration date
05/22/2008
Last updated
07/06/2023
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