Provider Demographics
NPI:1184633950
Name:PARK, YOUNG S (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:S
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2123 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9477
Mailing Address - Country:US
Mailing Address - Phone:630-922-3494
Mailing Address - Fax:630-922-5834
Practice Address - Street 1:2123 SKYLANE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9477
Practice Address - Country:US
Practice Address - Phone:630-922-3494
Practice Address - Fax:630-922-5834
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36049611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice