Provider Demographics
NPI:1386186955
Name:PARK, CHEONG W
Entity Type:Individual
Prefix:
First Name:CHEONG
Middle Name:W
Last Name:PARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 72ND ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-1738
Mailing Address - Country:US
Mailing Address - Phone:253-642-7850
Mailing Address - Fax:253-642-7849
Practice Address - Street 1:31217 PACIFIC HWY S
Practice Address - Street 2:A-101
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5401
Practice Address - Country:US
Practice Address - Phone:253-642-7850
Practice Address - Fax:253-642-7849
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician