Healthcare Provider Details

I. General information

NPI: 1750679569
Provider Name (Legal Business Name): YEOUNKYOUNG PARK RN, ANP, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA PARK NEONATAL NP

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

2433 SIERRA MADRE AVE
CLOVIS CA
93611-6527
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-3961
  • Fax:
Mailing address:
  • Phone: 559-253-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number95001621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: