Provider Demographics
NPI:1740683663
Name:PARK, CHUN HYUNG (DC)
Entity type:Individual
Prefix:
First Name:CHUN HYUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1435
Mailing Address - Country:US
Mailing Address - Phone:201-994-6485
Mailing Address - Fax:
Practice Address - Street 1:21519 39TH AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2114
Practice Address - Country:US
Practice Address - Phone:201-994-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00718200111N00000X
NYX012779-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor