| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ELLEN CHANG PARK | 1659007797 | 2022-10-20 |
Ellen Chang Park is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1659007797. Registration indicates Ellen Chang Park is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Adult Health, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Adult Health, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Entity Type | Individual |
| Provider Name | Ellen Chang Park NP |
| Practice Office Address | 2 KORET WAY SAN FRANCISCO, CA US |
| Practice Office Telephone | 4154761435 |
| Mailing Address | 2 KORET WAY SAN FRANCISCO, CA 941432218 US |
| Code | Practice | License No State |
|---|---|---|
| 363LA2200X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Adult Health All Other Specialties & Provider Types Nurse Practitioner Adult Health Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 95021937
CA |