Healthcare Provider Details

I. General information

NPI: 1205815107
Provider Name (Legal Business Name): YONG HOON PARK MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 EAST WASHINGTON BLVD.
WHITTIER CA
90602-1006
US

IV. Provider business mailing address

PO BOX 511228
LOS ANGELES CA
90051-3026
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax: 562-306-8200
Mailing address:
  • Phone: 562-698-0811
  • Fax: 562-309-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number8171
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG75600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: