| Doctor Name: | CHANG S PARK |
| NPI Number: | 1275554610 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | MD032283L |
| Business Practice Address: | 740 E State St Sharon, PA - 161463328 |
| Business Phone Number: | 7249833911 |
| Business Fax Number: | |
| Mailing Address: | 65 W Methodist Rd, GREENVILLE |
| State: | PA |
| Postal Code: | 161259712 |
| Phone Number: | 7245883799 |
| Fax Number: | |
| NPI Enumeration Date: | 07/21/2006 |
| NPI Last Update Date: | 05/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 04/18/2016 |
| NPI Reactivation Date: | 05/10/2016 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MD032283L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |