MEDICARE: JIN HYUK PARK M.D.

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	2080P0202X	Pediatric Cardiology Physician	0101232879	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

General Provider Information

NPI Number	:	1306824909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIN HYUK PARK M.D.

Provider Business Mailing Address
First Line	:	8500 EXECUTIVE PARK AVE
Second Line	:	SUITE 110
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2225
Country	:	US
Telephone Number	:	703-573-0504
Fax Number	:	703-573-4856

Provider Business Practice Location Address
First Line	:	8500 EXECUTIVE PARK AVE STE 110
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2228
Country	:	US
Telephone Number	:	703-573-0504
Fax Number	:	703-573-4856

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/21/2022

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