Active NPI
Chan J. Park, MD
- Surgery Physician
- Vermillion, SD
National Provider Identifier
1306894332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 5009
- Practice address
- 20 S Plum St
Vermillion, SD 57069-3346 - Phone
- (605) 624-9111
- Fax
- (605) 624-6636
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 5009 | SD | Primary |
Addresses
Primary practice location
20 S Plum St
Vermillion, SD 57069-3346
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7301822 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5009 | SD | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378944000000",
"number": "1306894332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5074",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175074",
"telephone_number": "605-328-6585",
"fax_number": "605-328-6512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 S PLUM ST",
"city": "VERMILLION",
"state": "SD",
"postal_code": "570693346",
"telephone_number": "605-624-9111",
"fax_number": "605-624-6636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "CHAN",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2013-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "SD",
"license": "5009",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301822",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vermillion, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.