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General NPI Number Information
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NPI Number | 1144373150
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Entity Type | Individual
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Provider Name | JAMES K PARK M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 8330 BOONE BLVD STE 160
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City | VIENNA
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State | VA
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Zip | 22182-2678
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Country | US
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Telephone | 703-354-2200
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Fax | 703-977-1728
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Provider Business Mailing Address
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Address Line | 4600 JOHN MARR DR SUITE 101
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City | ANNANDALE
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State | VA
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Zip | 22003-3310
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Country | US
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Telephone | 703-354-2200
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Fax | 571-323-3938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101840533
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License Number State | VA
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