Provider Demographics
NPI:1265429161
Name:PARK, YOUN W (MD)
Entity type:Individual
Prefix:DR
First Name:YOUN
Middle Name:W
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 5TH ST SE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4255
Mailing Address - Country:US
Mailing Address - Phone:330-753-9763
Mailing Address - Fax:330-753-1086
Practice Address - Street 1:105 5TH ST SE
Practice Address - Street 2:SUITE 4
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4255
Practice Address - Country:US
Practice Address - Phone:330-753-9763
Practice Address - Fax:330-753-1086
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043203207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398681Medicaid
OH791043208OtherMEDICARE RAILROAD PTAN
OH0398681Medicaid
OH0465971Medicare PIN