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General NPI Number Information
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NPI Number | 1265429161
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Entity Type | Individual
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Provider Name | YOUN W PARK MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 105 5TH ST SE SUITE 4
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City | BARBERTON
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State | OH
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Zip | 44203-4255
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Country | US
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Telephone | 330-753-9763
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Fax | 330-753-1086
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Provider Business Mailing Address
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Address Line | 105 5TH ST SE SUITE 4
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City | BARBERTON
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State | OH
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Zip | 44203-4255
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Country | US
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Telephone | 330-753-9763
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Fax | 330-753-1086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35043203
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License Number State | OH
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