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General NPI Number Information
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NPI Number | 1497391601
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Entity Type | Individual
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Provider Name | HYESIN PARK
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 4229 LAFAYETTE CENTER DR STE 1350
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City | CHANTILLY
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State | VA
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Zip | 20151-1268
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Country | US
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Telephone | 571-206-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 13929 ANTONIA FORD CT
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City | CENTREVILLE
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State | VA
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Zip | 20121-3563
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000944
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License Number State | VA
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