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General NPI Number Information
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NPI Number | 1992894554
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Entity Type | Individual
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Provider Name | MRS. KYU JA PARK
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20422-0001
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Country | US
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Telephone | 202-745-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 MARY ELLEN CT
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City | MCLEAN
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State | VA
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Zip | 22101-5021
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Country | US
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Telephone | 703-847-9726
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 030963-1
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License Number State | NY
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