Active NPI
Chan H Park, MD
- Nuclear Imaging & Therapy Physician
- Philadelphia, PA
National Provider Identifier
1659384774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Imaging & Therapy Physician
- License
- MD031852L
- Practice address
- 3900 Woodland Ave
Philadelphia, PA 19104-4551 - Phone
- (215) 823-6270
- NPI assigned
- Aug 14, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Cardiology Physician | 207UN0901X | MD031852L | PA | |
| Nuclear Imaging & Therapy Physician | 207UN0902X | MD031852L | PA | Primary |
Addresses
Primary practice location
3900 Woodland Ave
Philadelphia, PA 19104-4551
Mailing address
111 Camelot LN
Newtown Square, PA 19073-4412
Phone (610) 353-0479
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD031852L | PA | MD | Nuclear Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1659384774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 CAMELOT LN",
"city": "NEWTOWN SQUARE",
"state": "PA",
"postal_code": "190734412",
"telephone_number": "610-353-0479",
"fax_number": "215-823-4312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 WOODLAND AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044551",
"telephone_number": "215-823-6270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "CHAN",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207UN0901X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Cardiology",
"state": "PA",
"license": "MD031852L",
"primary": false
},
{
"code": "207UN0902X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
"state": "PA",
"license": "MD031852L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.