Provider Demographics
NPI:1538316823
Name:PARK, YUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:YUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 5TH AVE, 2ND FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2119
Mailing Address - Country:US
Mailing Address - Phone:212-812-4917
Mailing Address - Fax:
Practice Address - Street 1:210 5TH AVE, 2ND FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-812-4917
Practice Address - Fax:212-812-4917
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0517822084P0800X, 207R00000X, 2084P0015X
NY2867282084P0800X, 207R00000X, 2084P0800X, 2084P0800X
KS94-07077390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY851713866OtherCOMMERCIAL INSURANCE