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1922388404 NPI number — YONG J PARK RPH

NPI Number: 1922388404
Health Care Provider/Practitioner: YONG J PARK RPH

Information about “1922388404” NPI (YONG J PARK RPH) exists in 1922388404 in HTML format HTML  |  1922388404 in plain Text format TXT  |  1922388404 in PDF (Portable Document Format) PDF  |  1922388404 in an XML format XML  formats.

NPI Number : 1922388404 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922388404",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PARK",
    "FirstName": "YONG",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PARK",
    "OtherFirstName": "ERIC",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RPH",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4605 BIRCHWOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SKOKIE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60076-3872",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-894-8726",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4801 N LINCOLN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60625-1915",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-561-2526",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/28/2011",
    "LastUpdateDate": "08/28/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "051.289189",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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