Provider Demographics
NPI:1205984317
Name:PARK, YONG J (OD)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:J
Last Name:PARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2609 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3511
Mailing Address - Country:US
Mailing Address - Phone:818-541-0370
Mailing Address - Fax:818-541-0376
Practice Address - Street 1:2609 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3511
Practice Address - Country:US
Practice Address - Phone:818-541-0370
Practice Address - Fax:818-541-0376
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12228T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist