Healthcare Provider Details

I. General information

NPI: 1174613681
Provider Name (Legal Business Name): YOONG JONG PARK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W AVENUE J
LANCASTER CA
93534-2700
US

IV. Provider business mailing address

101 S 1ST ST SUITE 1000
BURBANK CA
91502-1938
US

V. Phone/Fax

Practice location:
  • Phone: 661-952-1100
  • Fax: 661-952-1103
Mailing address:
  • Phone: 818-845-6206
  • Fax: 818-845-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA30985
License Number StateCA

VIII. Authorized Official

Name: DR. YOONG JONG PARK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-945-5780