Healthcare Provider Details

I. General information

NPI: 1700704988
Provider Name (Legal Business Name): YUNSOO PARK PH.D.
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 CEDAR LN SE # 4152
VIENNA VA
22180-6613
US

IV. Provider business mailing address

278 CEDAR LN SE # 4152
VIENNA VA
22180-6613
US

V. Phone/Fax

Practice location:
  • Phone: 571-307-4649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006356
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: