Provider Demographics
NPI:1508211558
Name:PARK, CHELSEA JISEON (DO)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JISEON
Last Name:PARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N MACARTHUR BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2217
Mailing Address - Country:US
Mailing Address - Phone:972-817-1000
Mailing Address - Fax:972-817-1449
Practice Address - Street 1:2021 N MACARTHUR BLVD STE 350
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2217
Practice Address - Country:US
Practice Address - Phone:972-817-1000
Practice Address - Fax:972-817-1449
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine