Provider Demographics
NPI:1811104607
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHONG MIN
Authorized Official - Middle Name:
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:814-226-7801
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:814-226-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428499207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty