Provider Demographics
NPI:1699352625
Name:PARK, RICHARD YOUNG (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:YOUNG
Last Name:PARK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23175 COMMERCE PARK STE C
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5806
Mailing Address - Country:US
Mailing Address - Phone:440-588-8197
Mailing Address - Fax:
Practice Address - Street 1:23175 COMMERCE PARK STE C
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5806
Practice Address - Country:US
Practice Address - Phone:440-588-8197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.004193213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery