Provider Demographics
NPI:1174764724
Name:PARK, GYE YOUNG (MD)
Entity type:Individual
Prefix:
First Name:GYE YOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GYE
Other - Middle Name:Y
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:MC719 ROOM 920N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-8039
Mailing Address - Fax:312-996-4665
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:MC719 ROOM 920N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-8039
Practice Address - Fax:312-996-4665
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL36123031207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine