Individual
DR. SOO WOONG PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10680 MAIN ST, STE 130, FAIRFAX, VA 22030-3811
(703) 273-6802
(703) 273-3960
Mailing address
10680 MAIN ST, STE 130, FAIRFAX, VA 22030-3811
(703) 273-6802
(703) 273-3960
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101029694
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6075550
—
VA
Enumeration date
07/07/2005
Last updated
11/13/2009
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