Provider Demographics
NPI:1619126281
Name:PARK, YOUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 NE BEL RED RD
Mailing Address - Street 2:STE 112
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2510
Mailing Address - Country:US
Mailing Address - Phone:425-484-9023
Mailing Address - Fax:206-309-9063
Practice Address - Street 1:12505 NE BEL RED RD
Practice Address - Street 2:STE 112
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2510
Practice Address - Country:US
Practice Address - Phone:425-484-9023
Practice Address - Fax:206-309-9063
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60105742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor