Provider Demographics
NPI:1831285691
Name:PARK, YOUNGSOOK (MD)
Entity Type:Individual
Prefix:
First Name:YOUNGSOOK
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 1:10600 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5110
Mailing Address - Country:US
Mailing Address - Phone:708-202-2844
Mailing Address - Fax:798-202-7936
Practice Address - Street 1:10600 31ST ST
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5110
Practice Address - Country:US
Practice Address - Phone:708-202-2844
Practice Address - Fax:708-202-7936
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist