Chan Hoon Park, MD
Individual provider Active NPI Family Medicine Physician · Slatersville, RI
NPI 1700092103 · NPPES record last updated Feb 26, 2008
Key facts
- NPI
- 1700092103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD 5083 (RI)
- Practice address
- 905 Victory Hwy
Slatersville, RI 02876 - Phone
- (401) 762-2728
- Fax
- (401) 762-0473
- NPI assigned
- May 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 5083 | RI | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD 5083 | RI | Yes |
Addresses
Primary practice location
905 Victory Hwy
Slatersville, RI 02876
Mailing address
905 Victory Hwy
PO Box 177
Slatersville, RI 02876
Phone (401) 762-2728
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001727 | Other | RI | BLUE CHIP |
| 1260-1 | Other | RI | BLUE CROSS BLUE SHIELD |
| 0100118 | Other | PR | UNITED HEALTHCARE |
| 9001260 | Medicaid | RI |
Other providers in Slatersville, RI
- Elizabeth Kubiak
- Maha Maaita
- Joseph Mallouh
- Maxi Drug South LP
- Robert Murphy
- Craig Anthony Simpson
- Denise A. Sloane
- Marshall M Sommer
- Tak-PO Anthony Yu
All providers in Slatersville, RI · Family Medicine Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.