Provider Demographics
NPI:1235214131
Name:PARK, CHARLES KEYU (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEYU
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5536
Mailing Address - Country:US
Mailing Address - Phone:303-800-6463
Mailing Address - Fax:303-500-6585
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 420
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5536
Practice Address - Country:US
Practice Address - Phone:303-800-6463
Practice Address - Fax:303-500-6585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH426642084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry