Park, Chan J.
Park, Chan J. is an individual health care provider with primary practice located at 20 S Plum St , Vermillion SD 57069-3346. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Park, Chan J. can be contacted via phone (605) 624-9111.Contact Information
Primary practice address
20 S Plum St
Vermillion SD 57069-3346
Phone: (605) 624-9111
Fax: (605) 624-6636
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 5009 | South Dakota |
Profile Details
| NPI number | 1306894332 |
|---|---|
| LBN Legal business name | Park, Chan J. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2006 |
| Last updated | Sep 12th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306894332 | NPPES |
| South Dakota | MEDICAID | 7301822 |
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