| Doctor Name: | DR. YOUNG JA PARK |
| NPI Number: | 1720077217 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 133910-1 |
| Business Practice Address: | 18th Medcom Atts: Dccs-qm (credentials) Apo, AP - 96205-0054 |
| Business Phone Number: | 0118227916 |
| Business Fax Number: | 01182279178110 |
| Mailing Address: | 18th Medcom, Attn: Dccs-qm (credentials) APO |
| State: | AP |
| Postal Code: | 96295-0054 |
| Phone Number: | 0118227916 |
| Fax Number: | 01182279178110 |
| NPI Enumeration Date: | 10/18/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 133910-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |