Individual
JEE SON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
3554 CHAIN BRIDGE RD STE 200, FAIRFAX, VA 22030-2709
(703) 896-7628
(703) 844-3223
Mailing address
154 TROUT LILY DR, LAKE FREDERICK, VA 22630-1909
(703) 628-2248
(703) 844-3223
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024182788
VA
Other
Enumeration date
09/27/2021
Last updated
11/26/2025
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