MEDICARE: YOUNGJUN PARK MD

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	208M00000X	Hospitalist Physician	293184	NY
2	207RN0300X	Nephrology Physician	293184	NY

General Provider Information

NPI Number	:	1275971004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNGJUN PARK MD

Provider Business Mailing Address
First Line	:	86 SAINT FELIX ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3032
Country	:	US
Telephone Number	:	718-250-6813
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 SAINT FELIX ST FL 8
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3032
Country	:	US
Telephone Number	:	718-250-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	05/28/2021

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