Chan S. Park, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0101043881 Issued in VA

Practice address

Michumi, PLLC Dba Med Express of Williamsburg, VA
120 Monticello Ave
Williamsburg, VA 23185

Phone

(757) 564-3627

Fax

(757) 564-6449

NPI assigned

Feb 9, 2006

Last updated

Aug 7, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michumi PLLC

  dba MD Express

  • Emergency Medicine Physician
  • Williamsburg, VA
  • NPI 1255388021
  Medicare reassignment NPD
• Peninsula Radiological Associates Limited

  • Diagnostic Radiology Physician
  • Newport News, VA
  • NPI 1114030426
  NPD (past)
• Riverside Emergency Physicians LLP

  • Emergency Medicine Physician
  • Gloucester, VA
  • NPI 1609891746
  NPD (past)

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218067200000",
    "number": "1619940681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5508",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234710508",
            "telephone_number": "757-340-3489",
            "fax_number": "757-340-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MICHUMI, PLLC DBA MED EXPRESS OF WILLIAMSBURG, VA",
            "address_2": "120 MONTICELLO AVE",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "23185",
            "telephone_number": "757-564-3627",
            "fax_number": "757-564-6449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHAN",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2008-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101043881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMED",
            "identifier": "P00153223",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010094321",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Paolicelli, LPN
• Carli C Papas-Pasco, LCSW
• Jamie Paquette, DC
• Pranav H. Parikh, M.D.
• Richard A Parisi, MD
• Dallin Douglas Parkinson, LMFT
• Sarah Painter Parks, MSW
• John C Paschold, MD
• Anisha Dipen Patel, D.D.S
• Henilben D Patel

• Emergency Medicine Physician in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Emergency Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.