NPIMap

Individual provider Active NPI

Soo Jung Park, PA-C

  • Physician Assistant
  • Dulles, VA
National Provider Identifier
1225836844
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110010844 Issued in VA
Practice address
24430 Stone Springs Blvd Suite 275
Dulles, VA 20166-2270
Phone
(703) 858-3220
NPI assigned
Mar 7, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 0110010844 VA Primary

Addresses

Primary practice location

24430 Stone Springs Blvd Suite 275
Dulles, VA 20166-2270

Mailing address

224-D Cornwall Street, NW, Suite 403
Leesburg, VA 20176-2704
Phone (703) 737-6010

Other practice location 1

Msc 4315 235 Martin Luther King Jr Way
Harrisonburg, VA 22807-0001
Phone (540) 568-7658

Other identifiers 1

IdentifierTypeStateIssuer
30018274670001MedicaidVA

Other names 1

  • Crystal Park Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250620000776 VA Practitioner - Physician Assistant 2961914593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Loudoun Medical Group, PCGroup PAC ID 0042119661, 272 clinicians

Practice addresses (Care Compare)

205 Hirst Rd
Purcellville, VA 20132-6602

20955 Professional PLZ
Suite 200
Ashburn, VA 20147-3405
Phone (703) 729-7652

44055 Riverside Pkwy
Leesburg, VA 20176-5176

Hospital & facility affiliations

  • Inova Loudoun Hospital Hospital, Leesburg, VA, CCN 490043
  • Stonesprings Hospital Center Hospital, Dulles, VA, CCN 490145

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Loudoun Medical Group, PC CurrentSince Jun 2, 2025 Accepting new patients
Loudoun Medical Group, PC CurrentSince Jun 2, 2025 Accepting new patients

Locations

20955 Professional Plz
Ste 200
Ashburn, VA 20147
Phone (703) 729-7652

24430 Stone Springs Blvd
Ste 275
Dulles, VA 20166
Phone (703) 858-3220

224D Cornwall St NW
Ste 403
Leesburg, VA 20176
Phone (703) 737-6001

Interoperability endpoints

  • Direct secure messaging: soojung.park@lmg1.eclinicaldirectplus.com

Organizations & group practices 10

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1741305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1225836844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL STREET, NW, SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24430 STONE SPRINGS BLVD SUITE 275",
            "city": "DULLES",
            "state": "VA",
            "postal_code": "201662270",
            "telephone_number": "703-858-3220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Msc 4315 235 Martin Luther King Jr Way",
            "address_purpose": "LOCATION",
            "city": "Harrisonburg",
            "state": "VA",
            "postal_code": "228070001",
            "country_code": "US",
            "telephone_number": "540-568-7658",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SOO JUNG",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-07",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30018274670001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "PARK",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dulles, VA

Sources for this page

Verify at the official NPI Registry.