Provider Demographics
NPI:1578557260
Name:CHUNG-PARK, MIN S (RN, NP, PHD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:S
Last Name:CHUNG-PARK
Suffix:
Gender:F
Credentials:RN, NP, PHD
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Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:NAVAL MEDICAL CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5000
Mailing Address - Country:US
Mailing Address - Phone:619-524-6185
Mailing Address - Fax:619-524-6191
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NAVAL MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-524-6185
Practice Address - Fax:619-524-6191
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA275715363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN