Organization · NPI-2

Chan Park MD INC

Family Medicine · Slatersville, RI

NPI number1104865849
StatusActive
Last updated in NPPESFeb 26, 2008

Details

NPI
1104865849
Entity type
Organization (NPI-2)
Legal business name
Chan Park MD INC
Organization subpart
No
Enumeration date
Jun 6, 2006
Last updated
Feb 26, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineMD5083RIYes

Practice location

905 Victory Highway
Slatersville, RI 02876

Phone 401-762-2728 · Fax 401-762-0473

Mailing address

Po Box 177
905 Victory Hwy
Slatersville, RI 02876

Phone 401-762-2728 · Fax 401-762-0473

Authorized official

Chan Hoon Park
Owner
4017622728

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