Provider Demographics
NPI:1063467207
Name:PARK, YOUNG CHA (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:CHA
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:C
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1177 QUEEN STREET,
Mailing Address - Street 2:SUITE 1708
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4144
Mailing Address - Country:US
Mailing Address - Phone:808-591-6585
Mailing Address - Fax:
Practice Address - Street 1:1481 S KING ST
Practice Address - Street 2:#422
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2601
Practice Address - Country:US
Practice Address - Phone:808-398-2103
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI 11088207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI565963Medicaid
HI565963Medicaid
HI100249Medicare ID - Type Unspecified