Provider Demographics
NPI:1982766168
Name:PARK, YUNG J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:YUNG
Middle Name:J
Last Name:PARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 HUNTINGTON DR SOUTH
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1698
Mailing Address - Country:US
Mailing Address - Phone:323-222-2362
Mailing Address - Fax:323-225-4171
Practice Address - Street 1:5014 HUNTINGTON DR SOUTH
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1698
Practice Address - Country:US
Practice Address - Phone:323-222-2362
Practice Address - Fax:323-225-4171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40035183500000X
CAPHY368713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA368710Medicaid
CARPH40035OtherBOARD OF PHARMACY
CA1122650001Medicare NSC