Individual
DR. HAE DUK PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
8714 SUDLEY RD, MANASSAS, VA 20110-4405
(703) 368-8166
(703) 368-8624
Mailing address
8714 SUDLEY RD, MANASSAS, VA 20110-4405
(703) 368-8166
(703) 368-8624
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410598
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401410598
VA DENTAL LIC#
VA
01
—
1745319
UNITED CONCORDIA INS.ID
PA
01
—
178830
ANTHEM BCBS ID #
VA
Enumeration date
10/25/2006
Last updated
03/07/2023
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