Chan-Shik Park, MD PHD

Primary specialty

Molecular Genetic Pathology (Medical Genetics) PhysicianTaxonomy code 207SM0001X

License

233065 Issued in MA

Practice address

75 Francis St
BWH, Department of Pathology
Boston, MA 02115-6110

Phone

(617) 732-7510

NPI assigned

Aug 7, 2007

Last updated

Aug 7, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186444800000",
    "number": "1588855324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "address_2": "BWH, DEPARTMENT OF PATHOLOGY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "address_2": "BWH, DEPARTMENT OF PATHOLOGY",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHAN-SHIK",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-07",
        "last_updated": "2007-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SM0001X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Molecular Genetic Pathology",
            "state": "MA",
            "license": "233065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soja Park Bennett, MD
• Park Prosthodontics, PLLC
• Park Prosthodontics, PLLC
• Agnes Park, MD
• Carly F Park, DMD
• Changhee Park, NP
• Charlie Chulhyun Park, MD
• Christopher Park
• Chul-Wan Park, DDS
• Cindy Park, MD

• Molecular Genetic Pathology (Medical Genetics) Physician in Boston, MA
• Providers in Boston, MA by specialty
• Molecular Genetic Pathology (Medical Genetics) Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.