Provider Demographics
NPI:1083216345
Name:PARK, YU JIN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:YU JIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1023 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4616
Mailing Address - Country:US
Mailing Address - Phone:858-776-3941
Mailing Address - Fax:
Practice Address - Street 1:3914 MURPHY CANYON RD # 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4491
Practice Address - Country:US
Practice Address - Phone:858-776-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician