Provider Demographics
NPI:1790864940
Name:PARK, JULIANA YOUNGMIN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:YOUNGMIN
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE B-103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-573-9688
Mailing Address - Fax:703-207-9396
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE B-103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-573-9688
Practice Address - Fax:703-207-9396
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010154277207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340868OtherALLIANCE
VA5357721OtherAETNA
VAF051-0001OtherCAREFIRST
VA1031145OtherFIRSTHEALTH,MAILHANDLERS,
VA140964OtherANTHEM & BCBS FEDERAL
VA1031145OtherFIRSTHEALTH,MAILHANDLERS,
VA340868OtherALLIANCE