DR. SOO WOONG PARK (NPI# 1205833910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205833910 |
| Entity Type | Individual |
| Full Name | DR. SOO WOONG PARK |
| Other Name | DR. SOO W PARK |
| Credential | M.D. |
| Practice Address |
10680 Main St Ste 130 Fairfax VA 22030-3811 |
| Practice Telephone | 7032736802 |
| Practice Fax Number | 7032733960 |
| Mailing Telephone | 7032736802 |
| Mailing Fax Number | 7032733960 |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2009-11-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 0101029694 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 6075550 | 05 |
| Street Address |
10680 MAIN ST STE 130 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-3811 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043767874 | Kelly Gallo | Nurse Practitioner | 10680 Main St, Suite 190, Fairfax, VA 22030-3810 | 2016-09-09 |
| 1801202536 | Care Advantage Inc | Home Health | 10680 Main St, Fairfax, VA 22030-3810 | 2014-07-02 |
| 1467690743 | T & J Chiropractic Inc | Acupuncturist | 10680 Main St, Suite 275, Fairfax, VA 22030-3810 | 2009-01-26 |
| 1619075330 | Jong Hee Cho | Chiropractor | 10680 Main St, Suite 275, Fairfax, VA 22030-3810 | 2006-09-20 |
| 1578570040 | Jamie H Park | Dentist | 10680 Main St, Suite 150, Fairfax, VA 22030-3810 | 2006-08-01 |
| 1821054933 | James Patrick Kacedan | Obstetrics & Gynecology | 10680 Main St, Suite 190, Fairfax, VA 22030-3810 | 2006-04-26 |
| 1407824881 | Al-juburi Urology, Pllc | Specialist | 10680 Main St, Suite 100, Fairfax, VA 22030-3810 | 2006-03-10 |
| 1396729372 | Amer Z Al-juburi | Specialist | 10680 Main St, Suite 100, Fairfax, VA 22030-3810 | 2005-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235737248 | Alpa Patel Md Pllc | Internal Medicine | 3020 Hamaker Ct Ste B106, Fairfax, VA 22031-2236 | 2020-10-12 |
| 1295223931 | Maturi Medical Group LLC | Internal Medicine | 2751 Prosperity Ave Ste 440, Fairfax, VA 22031-4397 | 2018-04-27 |
| 1447518519 | Kevin A Draper | Internal Medicine | 4702 Sandra Ln, Fairfax, VA 22030-5409 | 2012-04-26 |
| 1184945982 | Angela Pennisi | Internal Medicine | 8081 Innovation Park Dr Fl 3, Fairfax, VA 22031-4867 | 2010-06-15 |
| 1326273228 | Medical Clinics of West Virginia Pllc | Internal Medicine | 2826 Old Lee Hwy, Ste 250, Carelife Medical, Fairfax, VA 22031-4348 | 2009-05-20 |
| 1215179254 | Robert Douglas Janke | Internal Medicine | 8221 Willow Oaks Corporate Dr # 4-420, Fairfax, VA 22031-4512 | 2009-04-06 |
| 1932341849 | Henry Dearborn Ziegler | Internal Medicine | 4300 Thomas Brigade Ln, Fairfax, VA 22033-4273 | 2009-03-25 |
| 1073791513 | Benson W. Yu M.d. Pllc | Internal Medicine | 3601 Chain Bridge Rd Ste D, Fairfax, VA 22030-3243 | 2008-02-06 |
| 1255534301 | Lishan Kassa | Internal Medicine | 10520 Judicial Drive, Medical Section, Fairfax, VA 22030 | 2007-06-07 |
| 1770636508 | Chin Oh Kim | Internal Medicine | 3930 Pender Dr Ste 320, Fairfax, VA 22030-0986 | 2007-01-18 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.