MEDICARE: DR. YOUNG JA 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	171000000X	Military Health Care Provider	133910-1	NY

General Provider Information

NPI Number	:	1720077217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUNG JA PARK

Provider Business Mailing Address
First Line	:	18TH MEDCOM
Second Line	:	ATTN: DCCS-QM (CREDENTIALS)
City	:	APO
State	:	AP
Zip	:	96295-0054
Country	:	KR
Telephone Number	:	11-822-7916
Fax Number	:	01182279178110

Provider Business Practice Location Address
First Line	:	18TH MEDCOM
Second Line	:	ATTS: DCCS-QM (CREDENTIALS)
City	:	APO
State	:	AP
Zip	:	96205-0054
Country	:	KR
Telephone Number	:	11-822-7916
Fax Number	:	01182279178110

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/21/2022

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Directions to “ DR. YOUNG JA PARK ” Practice Location

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