Soo Woong Park, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101029694 Issued in VA

Practice address

10680 Main St
Ste 130
Fairfax, VA 22030-3811

Phone

(703) 273-6802

Fax

(703) 273-3960

NPI assigned

Jul 7, 2005

Last updated

Nov 13, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Soo W Park Other name

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Harmony in Health LLC

  dba Harmony In Health

  • Primary Care Clinic/Center
  • Fairfax, VA
  • NPI 1265845796
  NPD (past)
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258070400000",
    "number": "1205833910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10680 MAIN ST",
            "address_2": "STE 130",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303811",
            "telephone_number": "703-273-6802",
            "fax_number": "703-273-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10680 MAIN ST",
            "address_2": "STE 130",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303811",
            "telephone_number": "703-273-6802",
            "fax_number": "703-273-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SOO WOONG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2009-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101029694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6075550",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOO",
            "last_name": "PARK",
            "middle_name": "W",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Min Park, NP
• Pamela Park, OTR
• Patricia S. Park, SLP
• Priscilla J Park
• Songki Park, NP
• Allison Parker
• David A Parker, MD
• Helen Parker, PT
• Jack E Parker
• Jaclyn Parker

• Internal Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; 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.

Verify at the official NPI Registry.