Provider Demographics
NPI:1205815107
Name:PARK, YONG HOON (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:HOON
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511228
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3026
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-309-8200
Practice Address - Street 1:12401 EAST WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-306-8200
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV81712085R0204X
CAG756002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV9189OtherBLUE
CAP00664706OtherRR MEDICARE
NV200290212Medicaid
CA00G756000Medicaid
NV200290212Medicaid
CAAW069ZMedicare PIN
NV30106Medicare PIN
NV300075979Medicare PIN