Provider Demographics
NPI:1295188456
Name:PARK, YOOKYUNG ANDREA (OD)
Entity Type:Individual
Prefix:DR
First Name:YOOKYUNG
Middle Name:ANDREA
Last Name:PARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SAINT JOHNS PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4306
Mailing Address - Country:US
Mailing Address - Phone:917-873-3341
Mailing Address - Fax:
Practice Address - Street 1:210 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6228
Practice Address - Country:US
Practice Address - Phone:212-877-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist