Healthcare Provider Details

I. General information

NPI: 1427311851
Provider Name (Legal Business Name): BRIAN BYUNGJIN PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR STE 302
GAINESVILLE VA
20155-3260
US

IV. Provider business mailing address

PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-0653
  • Fax: 571-248-0658
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101255026
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101255026
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: