Organization
DOD
Active
Other names
MEDDAC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KYUNG OK PARK BSN (CLINICAL NURSE)
(703) 805-0067
Entity
Organization
Contact information
Practice address
9501 FARRELL RD, FORT BELVOIR, VA 22060-5901
(703) 805-0067
Mailing address
8637 HILLSIDE MANOR DR, SPRINGFIELD, VA 22152-2240
(703) 752-1776
Taxonomy
Speciality
Code
Description
License number
State
163WX0003X
Inpatient Obstetric Registered Nurse
Primary
0001109410
VA
Other
Enumeration date
12/19/2006
Last updated
08/22/2020
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