Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038011256 | IL |
NPI | 1154560696 |
---|---|
Provider Name | Dr. Yong Woon Park |
First Address | Skokie, IL 60077-3349 |
Second Address | Skokie, IL 60077-3349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2009 |
Last Update Date | 06/02/2009 |