Healthcare Provider Details

I. General information

NPI: 1003742891
Provider Name (Legal Business Name): JUYOUNG PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

4721 N ISLAND DR E
BONNEY LAKE WA
98391-8676
US

V. Phone/Fax

Practice location:
  • Phone: 253-223-0927
  • Fax:
Mailing address:
  • Phone: 253-223-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: