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General NPI Number Information
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NPI Number | 1427311851
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Entity Type | Individual
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Provider Name | BRIAN BYUNGJIN PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 7915 LAKE MANASSAS DR STE 302
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City | GAINESVILLE
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State | VA
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Zip | 20155-3260
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Country | US
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Telephone | 571-248-0653
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Fax | 571-248-0658
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Provider Business Mailing Address
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Address Line | PO BOX 381468
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City | GERMANTOWN
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State | TN
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Zip | 38183-1468
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Country | US
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Telephone |
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Fax |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0101255026
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101255026
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License Number State | VA
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