Healthcare Provider Details

I. General information

NPI: 1659832533
Provider Name (Legal Business Name): RACHEL HEE YOUNG PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 220
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

4660 KENMORE AVE STE 220
ALEXANDRIA VA
22304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 703-832-4000
  • Fax: 703-832-4001
Mailing address:
  • Phone: 703-832-4000
  • Fax: 703-832-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101284720
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: