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NPI Code Detail

MEDICARE: MR. YOUNG IL PARK FNP

MEDICARE: MR. YOUNG IL PARK FNP
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
1163W00000XRegistered Nurse95173940CA
2363LF0000XFamily Nurse Practitioner95023005CA

General Provider Information

NPI Number : 1811609100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. YOUNG IL PARK FNP
Provider Business Mailing Address
First Line : 525 N MADISON AVE APT 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-2285
Country : US
Telephone Number : 213-308-0777
Fax Number :
Provider Business Practice Location Address
First Line : 525 N MADISON AVE APT 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-2285
Country : US
Telephone Number : 213-308-0777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2022
Last Update Date : 12/19/2022

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