Provider Demographics
NPI:1639638794
Name:PARK, HYEYOUNG YEOM (MD)
Entity Type:Individual
Prefix:
First Name:HYEYOUNG
Middle Name:YEOM
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HYEYOUNG
Other - Middle Name:
Other - Last Name:YEOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 S RANCHO DR STE 4-740
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-242-6911
Mailing Address - Fax:
Practice Address - Street 1:840 S RANCHO DR STE 4-740
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3837
Practice Address - Country:US
Practice Address - Phone:702-242-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23857208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation