Healthcare Provider Details

I. General information

NPI: 1053660126
Provider Name (Legal Business Name): Y. W. PARK, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 5TH ST SE SUITE 4
BARBERTON OH
44203-4255
US

IV. Provider business mailing address

105 5TH ST SE SUITE 4
BARBERTON OH
44203-4255
US

V. Phone/Fax

Practice location:
  • Phone: 330-753-9763
  • Fax: 330-753-1086
Mailing address:
  • Phone: 330-753-9763
  • Fax: 330-753-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35043203
License Number StateOH

VIII. Authorized Official

Name: YOUN W. PARK
Title or Position: OWNER
Credential: M.D
Phone: 330-753-9763