| Doctor Name: | DR. YONG PARK |
| NPI Number: | 1205913761 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | LL528 |
| Business Practice Address: | 506 4th St Nw Jasper, FL - 320526603 |
| Business Phone Number: | 3867927200 |
| Business Fax Number: | 3867922084 |
| Mailing Address: | 506 4th St Nw, JASPER |
| State: | FL |
| Postal Code: | 320526603 |
| Phone Number: | 3867927200 |
| Fax Number: | 3867922084 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 01/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | LL528 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |