Active NPI
Hyuckwon Park, PA-C
- Physician Assistant
- Manassas, VA
National Provider Identifier
1073348876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110011559
- Practice address
- 8609 Sudley Rd Ste 105
Manassas, VA 20110-4500 - Phone
- (703) 393-8883
- Fax
- (866) 765-1362
- NPI assigned
- Sep 3, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110011559 | VA | Primary |
Addresses
Primary practice location
8609 Sudley Rd Ste 105
Manassas, VA 20110-4500
Mailing address
5100 Woodmere Dr # 320
Centreville, VA 20120-4325
Phone (726) 400-3708
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260219001687 | VA | Order and Referring Only - Physician Assistant | 9133609902 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110011559 | VA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771891200000",
"number": "1073348876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 WOODMERE DR # 320",
"city": "CENTREVILLE",
"state": "VA",
"postal_code": "201204325",
"telephone_number": "726-400-3708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8609 SUDLEY RD STE 105",
"city": "MANASSAS",
"state": "VA",
"postal_code": "201104500",
"telephone_number": "703-393-8883",
"fax_number": "866-765-1362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "HYUCKWON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-03",
"last_updated": "2026-02-24",
"certification_date": "2026-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110011559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manassas, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.