Active NPI
Young S Park, M.D.
- General Practice Physician
- Naperville, IL
National Provider Identifier
1184633950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 36049611
- Practice address
- 2123 Skylane Dr
Naperville, IL 60564-9477 - Phone
- (630) 922-3494
- Fax
- (630) 922-5834
- NPI assigned
- Aug 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 36049611 | IL | Primary |
Addresses
Primary practice location
2123 Skylane Dr
Naperville, IL 60564-9477
Mailing address
2123 Skylane Dr
Naperville, IL 60564-9477
Phone (630) 922-3494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36049611 | IL | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184633950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2123 SKYLANE DR",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605649477",
"telephone_number": "630-922-3494",
"fax_number": "630-922-5834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2123 SKYLANE DR",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605649477",
"telephone_number": "630-922-3494",
"fax_number": "630-922-5834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "YOUNG",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "36049611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.