Provider Demographics
NPI:1669554267
Name:PARK, HYUNG SOON (MD)
Entity type:Individual
Prefix:DR
First Name:HYUNG
Middle Name:SOON
Last Name:PARK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-670-4986
Mailing Address - Fax:703-590-7335
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-670-4986
Practice Address - Fax:703-590-7335
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010223412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7146809Medicaid
VA7146809Medicaid