Chan H Park, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

28108 Issued in AZ

Practice address

22226 Cliff Ave S
#304
Des Moines, WA 98198-4619

Phone

(253) 946-9365

Fax

(253) 946-9365

NPI assigned

May 30, 2012

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

Other names 1

• Dr. Chan H Park Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1700147378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22226 CLIFF AVE S",
            "address_2": "#304",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981984619",
            "telephone_number": "253-946-9365",
            "fax_number": "253-946-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22226 CLIFF AVE S",
            "address_2": "#304",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981984619",
            "telephone_number": "253-946-9365",
            "fax_number": "253-946-9365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-30",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "28108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHAN",
            "last_name": "PARK",
            "middle_name": "H",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Corin R Owens, LICSW
• Philip Owsley
• P3Ar Care & Management Services LLC
• Joseph Ignacio Pagdanganan
• Joshua Papac, D.D.S.
• Heather Robertson Parker
• Meghan Christopher Passovoy, DMD
• Tobin J Patrick, COTA
• Melissa Patridge
• Melissa Pearson

• Internal Medicine Physician in Des Moines, WA
• Providers in Des Moines, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; 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.