MEDICARE: YOUNGHAE LISA HYUN-PARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101050893	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134178965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNGHAE LISA HYUN-PARK MD

Provider Business Mailing Address
First Line	:	224-D CORNWALL STREET, NW, SUITE 403
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-2704
Country	:	US
Telephone Number	:	703-737-6010
Fax Number	:	703-443-8643

Provider Business Practice Location Address
First Line	:	19455 DEERFIELD AVENUE, SUITE 204
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-8102
Country	:	US
Telephone Number	:	703-858-1500
Fax Number	:	703-858-5022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	03/12/2024

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