MEDICARE: JI YOUNG PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		WA

General Provider Information

NPI Number	:	1205499290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI YOUNG PARK

Provider Business Mailing Address
First Line	:	19888 40TH AVE W UNIT B216
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-8073
Country	:	US
Telephone Number	:	619-730-9964
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 SAND POINT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7869
Country	:	US
Telephone Number	:	206-987-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	05/26/2026

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Directions to “ JI YOUNG PARK ” Practice Location

Language	Start Address	Practice Location

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