Provider Demographics
NPI:1801020946
Name:PARK, YOON JIN (MD)
Entity Type:Individual
Prefix:
First Name:YOON
Middle Name:JIN
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21600 HIGHWAY 99 STE 280
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8022
Mailing Address - Country:US
Mailing Address - Phone:425-582-7753
Mailing Address - Fax:425-740-0078
Practice Address - Street 1:21600 HIGHWAY 99 STE 280
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8022
Practice Address - Country:US
Practice Address - Phone:425-582-7753
Practice Address - Fax:425-740-0078
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60095980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8596041Medicaid
WAG8884125Medicare PIN