Healthcare Provider Details

I. General information

NPI: 1760933675
Provider Name (Legal Business Name): YURY PARK R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N HOBART BLVD
LOS ANGELES CA
90004-1805
US

IV. Provider business mailing address

419 N HOBART BLVD
LOS ANGELES CA
90004-1805
US

V. Phone/Fax

Practice location:
  • Phone: 213-219-3974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: