Lisa L Park, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

0101250887 Issued in VA

Practice address

4400 University Dr
Student Union Building 1, Room 2300
Fairfax, VA 22030-4422

Phone

(703) 993-2831

Fax

(703) 993-4365

NPI assigned

May 17, 2007

Last updated

Jan 11, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1699982868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 UNIVERSITY DR",
            "address_2": "STUDENT UNION BUILDING 1, ROOM 2300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304422",
            "telephone_number": "703-993-2831",
            "fax_number": "703-993-4365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 UNIVERSITY DR",
            "address_2": "STUDENT UNION BUILDING 1, ROOM 2300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304422",
            "telephone_number": "703-993-2831",
            "fax_number": "703-993-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "LISA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "VA",
            "license": "0101250887",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NJ",
            "license": "25MA08646300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie H Park, D.D.S.
• Jee Son Park, PMHNP-BC
• Jin Hyuk Park, M.D.
• Jonathan J Park, D.M.D.,M.D.
• Juliana Youngmin Park, M.D.
• Makenna Park
• Min Park, NP
• Pamela Park, OTR
• Patricia S. Park, SLP
• Priscilla J Park

• Pediatric Adolescent Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pediatric Adolescent Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.