Healthcare Provider Details

I. General information

NPI: 1356634083
Provider Name (Legal Business Name): SUNHEE PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190
US

IV. Provider business mailing address

11341 SUNSET HILLS RD
RESTON VA
20190-5205
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101258064
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: