Provider Demographics
NPI:1154368819
Name:PARK, YONG I (MD)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:I
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-0606
Mailing Address - Country:US
Mailing Address - Phone:215-785-0145
Mailing Address - Fax:215-785-0161
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:SUITE 510
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2624
Practice Address - Country:US
Practice Address - Phone:215-949-3100
Practice Address - Fax:215-949-8521
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4215532081P2900X
NJ25MA071206002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1630169OtherHIGHMARK BLUE SHIELD
PA1761794OtherAETNA
PA23-2919275OtherHEALTH AMERICA/HEALTH ASSURANCE
PA23-2919275OtherUNITED HEALTHCARE/OXFORD
NJ23-2993867OtherUNITED HEALTHCARE/OXFORD
NJ23-2919275OtherUNITED HEALTHCARE/OXFORD
PA50062619OtherCAPITAL BLUE CROSS
PA10451377Medicaid
NJ1193693OtherAETNA
PA1216431OtherAETNA
NJ22-1994560OtherFIRST MCO
PA23-2993867OtherDEVON
PAC0838608OtherBRAVO
PA23-2919275OtherHEALTH AMER./HEALTH ASS.
PA23-2919275OtherPROCURA MANAGEMENT
PA2306074000OtherKHPE, PERSONAL CHOICE, AMERIHEALTH
PA3252773OtherCIGNA
PA5747002OtherFIRST HEALTH NETWORK
PAP00451411OtherRAILROAD MEDICARE
PA50067193OtherCAPITAL BLUE CROSS
PA23-2993867OtherUNITED HEALTHCARE/OXFORD
PA999308OtherUPMC HEALTH PLAN
NJ23-2919275OtherHORIZON BCBS OF NJ
PA23-2919275OtherFIRST MCO
PAP3656794OtherOXFORD
PA23-2919275OtherDEVON
PA23-2919275OtherGREAT WEST HEALTHCARE
PA23-2993867OtherFIRST MCO
PA23-2993867OtherFIRST MCO
PAH34612Medicare UPIN
NJ047057RUZMedicare PIN
PA1761794OtherAETNA
PA50067193OtherCAPITAL BLUE CROSS
PA2306074000OtherKHPE, PERSONAL CHOICE, AMERIHEALTH
PA079277Medicare ID - Type Unspecified