Healthcare Provider Details

I. General information

NPI: 1922748268
Provider Name (Legal Business Name): YOUNG PARK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

200 E 62ND ST APT 28D
NEW YORK NY
10065-8327
US

V. Phone/Fax

Practice location:
  • Phone: 281-702-4356
  • Fax:
Mailing address:
  • Phone: 281-702-4356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number329392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: