Individual
IN YOUNG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2951 W FRONT STREET, CLINCH VALLEY MEDICAL PLAZA SUITE 1600, RICHLANDS, VA 24641
(276) 964-4001
(276) 964-4003
Mailing address
2951 W FRONT STREET, CLINCH VALLEY MEDICAL PLAZA SUITE 1600, RICHLANDS, VA 24641
(276) 964-4001
(276) 964-4003
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101029175
VA
207RN0300X
Nephrology Physician
0101029175
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236308
ANTHEM
VA
05
—
5879884
—
VA
Enumeration date
05/12/2006
Last updated
09/11/2025
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