Healthcare Provider Details

I. General information

NPI: 1023925666
Provider Name (Legal Business Name): SEUNG YUN PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 VALENCIA DR
COLTON CA
92324-1731
US

IV. Provider business mailing address

1432 ORANGE AVE APT 28
REDLANDS CA
92373-1418
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-5000
  • Fax:
Mailing address:
  • Phone: 425-207-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: