MEDICARE: DR. JIN HONG 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	207RG0100X	Gastroenterology Physician	0101234726	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	:	1225033038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIN HONG PARK MD

Provider Business Mailing Address
First Line	:	PO BOX 381468
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8640 SUDLEY RD STE 201
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4404
Country	:	US
Telephone Number	:	703-368-6819
Fax Number	:	703-330-2923

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/13/2026

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Directions to “ DR. JIN HONG PARK MD” Practice Location

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