Provider Demographics
NPI:1447291919
Name:PARK, CHUNG (MD)
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2227
Mailing Address - Country:US
Mailing Address - Phone:914-273-6988
Mailing Address - Fax:877-464-4042
Practice Address - Street 1:23 LYONS RD
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-2227
Practice Address - Country:US
Practice Address - Phone:914-273-6988
Practice Address - Fax:877-464-4042
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140413207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00120327OtherRAILROAD MEDICARE
NY00483110Medicaid
NY00483110Medicaid
NYC08376Medicare UPIN