Provider Demographics
NPI:1750679569
Name:PARK, YEOUNKYOUNG (RN, ANP, NNP-BC)
Entity type:Individual
Prefix:
First Name:YEOUNKYOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:RN, ANP, NNP-BC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NEONATAL NP
Mailing Address - Street 1:2433 SIERRA MADRE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6527
Mailing Address - Country:US
Mailing Address - Phone:559-253-3217
Mailing Address - Fax:
Practice Address - Street 1:2823 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1324
Practice Address - Country:US
Practice Address - Phone:559-459-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001621363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0233Medicaid