Provider Demographics
NPI:1154860104
Name:PARK, SUNG H (CFTS)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 OAKHAM PL
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-5214
Mailing Address - Country:US
Mailing Address - Phone:571-318-9711
Mailing Address - Fax:844-971-9711
Practice Address - Street 1:5602 OAKHAM PL
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-5214
Practice Address - Country:US
Practice Address - Phone:571-318-9711
Practice Address - Fax:844-971-9711
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter