Healthcare Provider Details

I. General information

NPI: 1578809703
Provider Name (Legal Business Name): HYUN S PARK YOON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2012
Last Update Date: 12/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 100TH ST SW
LAKEWOOD WA
98499-2752
US

IV. Provider business mailing address

5700 100TH ST SW
LAKEWOOD WA
98499-2752
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-3666
  • Fax:
Mailing address:
  • Phone: 253-588-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH53701
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15859
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: