Provider Demographics
NPI:1720191133
Name:PARK, SUNG-JUN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUNG-JUN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8133 LEESBURG PIKE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2706
Mailing Address - Country:US
Mailing Address - Phone:703-992-8992
Mailing Address - Fax:703-992-8180
Practice Address - Street 1:8133 LEESBURG PIKE
Practice Address - Street 2:SUITE 360
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2706
Practice Address - Country:US
Practice Address - Phone:703-992-8992
Practice Address - Fax:703-992-8180
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556502111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor