1134221781 NPI number — DR. YOUNG DON PARK MD

Table of content: DR. YOUNG DON PARK MD (NPI 1134221781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134221781 NPI number — DR. YOUNG DON PARK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARK
Provider First Name:
YOUNG
Provider Middle Name:
DON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134221781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3023 HAMAKER CT
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-641-9161
Provider Business Mailing Address Fax Number:
703-641-0383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224D CORNWALL ST NW
Provider Second Line Business Practice Location Address:
#306
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-641-9161
Provider Business Practice Location Address Fax Number:
703-641-0383
Provider Enumeration Date:
09/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0101234688 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: D0056761 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00025886 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2106571 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0009 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010015944 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246369 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C08696 . This is a "MEDICARE VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3152190 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2106571 . This is a "ALLIANCE GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 216677 . This is a "ANTHEM HEALTHKEEPERS PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "NALC AFFORDABLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P0002014 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010015898 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2160571 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76324434 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2106571 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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