Provider Demographics
NPI:1558516450
Name:CHONG MIN PARK, M.D. P.C.
Entity Type:Organization
Organization Name:CHONG MIN PARK, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHONG
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-226-7800
Mailing Address - Street 1:24 DOCTORS LN
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8568
Mailing Address - Country:US
Mailing Address - Phone:814-226-7800
Mailing Address - Fax:
Practice Address - Street 1:24 DOCTORS LN
Practice Address - Street 2:SUITE 304
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8568
Practice Address - Country:US
Practice Address - Phone:814-226-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428499207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty