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Individual

KI SOO PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
12825 MINNIEVILLE ROAD SUITE 201, LAKE RIDGE, VA 22192
(703) 647-3130
Mailing address
4610 LAWN CT, FAIRFAX, VA 22032
(571) 338-4865

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary

Other

Enumeration date
08/01/2019
Last updated
08/01/2019
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