Provider Demographics
NPI:1134221781
Name:PARK, YOUNG DON (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:DON
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 HAMAKER CT
Mailing Address - Street 2:#100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5216
Mailing Address - Country:US
Mailing Address - Phone:703-641-9161
Mailing Address - Fax:703-641-0383
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:#306
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-641-9161
Practice Address - Fax:703-641-0383
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234688207RC0000X
MDD0056761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00025886OtherRAILROAD MEDICARE
2106571OtherMDIPA
0009OtherCAREFIRST
VA010015944Medicaid
246369OtherANTHEM
541977219OtherCIGNA
VAC08696OtherMEDICARE VIRGINIA
3152190OtherAETNA HMO
2106571OtherALLIANCE GEHA
216677OtherANTHEM HEALTHKEEPERS PLUS
541977219OtherUNITED HEALTHCARE
541977219OtherNALC AFFORDABLE
P0002014OtherRAILROAD MEDICARE
MD010015898Medicaid
2160571OtherOPTIMUM CHOICE
76324434OtherAETNA PPO
2106571OtherMAMSI
2106571OtherMAMSI
2106571OtherALLIANCE GEHA
2106571OtherMDIPA
VA010015944Medicaid