Provider Demographics
NPI:1326703463
Name:PARK, JIN HYUNG (AUD)
Entity Type:Individual
Prefix:
First Name:JIN HYUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 BOULDER SPRINGS DR APT A1
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5524
Mailing Address - Country:US
Mailing Address - Phone:918-805-2583
Mailing Address - Fax:
Practice Address - Street 1:1001 E LEIGH ST FL 14
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5004
Practice Address - Country:US
Practice Address - Phone:804-828-0431
Practice Address - Fax:804-628-0950
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5583231H00000X
VA2201001854231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist