Provider Demographics
NPI:1972586055
Name:CLARK, YOOJIN PARK (DC)
Entity Type:Individual
Prefix:DR
First Name:YOOJIN
Middle Name:PARK
Last Name:CLARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:YOOJIN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:862 N MARQUIS WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1242
Mailing Address - Country:US
Mailing Address - Phone:925-314-6020
Mailing Address - Fax:925-999-9663
Practice Address - Street 1:9260 ALCOSTA BLVD STE A1
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4134
Practice Address - Country:US
Practice Address - Phone:925-999-9676
Practice Address - Fax:925-999-9663
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA699560OtherACN
CADC0299600OtherBLUE SHIELD OF CA
CA1063767OtherAMERICAN SPECIALTY HEALTH
CAV08148Medicare UPIN