DR. HAE DUK PARK (NPI# 1174607832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174607832 |
| Entity Type | Individual |
| Full Name | DR. HAE DUK PARK |
| Other Name | DR. KEN HAE PARK |
| Credential | D.M.D. |
| Practice Address |
8714 Sudley Rd Manassas VA 20110-4405 |
| Practice Telephone | 7033688166 |
| Practice Fax Number | 7033688624 |
| Mailing Telephone | 7033688166 |
| Mailing Fax Number | 7033688624 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
0401410598 | VA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | UNITED CONCORDIA INS.ID | 1745319 | 01 |
| VA | ANTHEM BCBS ID # | 178830 | 01 |
| VA | VA DENTAL LIC# | 0401410598 | 01 |
| VA | DEA | BP7915094 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225371842 | Hae Na Park | Pharmacist | 4101 Northview Dr, Pharmacy Department, Bowie, MD 20716-2616 | 2013-04-02 |
| 1225125701 | Hae K Park | Pediatrics | 3405 Mike Padgett Hwy, Augusta, GA 30906-3815 | 2006-10-06 |
| Street Address |
8714 SUDLEY RD |
| City | MANASSAS |
| State | VA |
| Zip Code | 20110-4405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518208602 | April Jae Brittain | Nurse Practitioner | 8714 Sudley Rd, Manassas, VA 20110-4405 | 2013-03-14 |
| 1679836746 | Nova Occupational Health Inc | Emergency Medicine | 8714 Sudley Rd, Manassas, VA 20110-4405 | 2012-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184246787 | Sini Eapen | Nurse Practitioner | 9380 Forestwood Lane, 9380 Unit B, Manassas, VA 20110 | 2020-05-18 |
| 1023662202 | United Health Home Care Agency | Registered Nurse | 8789 Commerce Ct#202, Manassas, VA 20110 | 2019-07-26 |
| 1750868097 | Elaine K. Sours, D.d.s., P.C. | Dentist | 8719 Plantation Lane, Manassas, VA 20110 | 2018-07-19 |
| 1962904573 | Donielle Francis | Specialist/Technologist | 10420 Monterosa Pl, Manassas, VA 20110 | 2018-02-28 |
| 1003332354 | Katrina Kask | Occupational Therapist | 6985 Centreville Rd., Manassas, VA 20110 | 2017-08-18 |
| 1477091478 | Mega Health Services, Inc | General Practice | 9602 Champion Ct, Manassas, VA 20110 | 2017-02-09 |
| 1811340599 | Malik Usman Dds, PC | Dentist | 8559 Sudley Road, Manassas, VA 20110 | 2016-07-19 |
| 1871944660 | Chitra Subbaraj | Physical Therapist | 8595 Centreville Rd, Manassas, VA 20110 | 2016-06-23 |
| 1093186512 | Daczkowski Orthodontics | Dentist | 8715 Stonewall Road, Manassas, VA 20110 | 2015-10-09 |
| 1851770366 | Candace Fleming | Counselor | 9242b Mosby St, Manassas, VA 20110 | 2015-05-29 |
| Find all providers in zip 20110 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750868097 | Elaine K. Sours, D.d.s., P.C. | Dentist | 8719 Plantation Lane, Manassas, VA 20110 | 2018-07-19 |
| 1609361849 | Rasha Jamal Hussein | Dentist | 12701 Galveston Ct, Manassas, VA 20112 | 2018-06-29 |
| 1265818363 | Good Choi's Dental Care, P.C. | Dentist | 10555 Crestwood Dr., Unit B, Manassas, VA 20109 | 2015-07-31 |
| 1801278726 | Happy Smile Dental, Inc | Dentist | 8428 Dorsey Cir Ste 201, Manassas, VA 20110-8302 | 2015-06-27 |
| 1497149132 | Sara Raja | Dentist | 6954 Jeremiah Ct, Manassas, VA 20111-4392 | 2015-03-19 |
| 1033508734 | Virginia Dental Partners Pllc | Dentist | 10482 Sudley Manor Drive, Manassas, VA 20109 | 2015-01-19 |
| 1992127989 | Dental Professionals of Virginia, P.c | Dentist | 11670 Sudley Manor Dr, Manassas, VA 20109-2842 | 2014-01-10 |
| 1427392729 | Eunice Song | Dentist | 9378 Forestwood Ln Ste A, Manassas, VA 20110-4742 | 2012-11-27 |
| 1154697720 | Vincy M Punnoose | Dentist | 10432 Balls Ford Rd, Suite 300, Manassas, VA 20109 | 2012-03-28 |
| 1295002814 | Neibauer Dental Care, PC | Dentist | 10051 Market Cir, Manassas, VA 20110-2120 | 2011-11-28 |
| Find all providers in MANASSAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.