MEDICARE: JOONG YOUNG PARK M.D. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A39059	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104014034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOONG YOUNG PARK M.D. INC.

Provider Business Mailing Address
First Line	:	9535 GARDEN GROVE BLVD STE 104
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1551
Country	:	US
Telephone Number	:	714-534-1112
Fax Number	:	714-534-1116

Provider Business Practice Location Address
First Line	:	9535 GARDEN GROVE BLVD STE 104
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1551
Country	:	US
Telephone Number	:	714-534-1112
Fax Number	:	714-534-1116

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOONG YOUNG PARK
Credential	:	M.D.
Telephone Number	:	714-534-1112

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	09/16/2009

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