DR. LISA L PARK (NPI# 1699982868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699982868 |
| Entity Type | Individual |
| Full Name | DR. LISA L PARK |
| Credential | MD |
| Practice Address |
4400 University Dr Student Union Building 1, Room 2300 Fairfax VA 22030-4422 |
| Practice Telephone | 7039932831 |
| Practice Fax Number | 7039934365 |
| Mailing Telephone | 7039932831 |
| Mailing Fax Number | 7039934365 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-01-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
0101250887 | VA | Allopathic & Osteopathic Physicians |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
25MA08646300 | NJ | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245837129 | Lisa Marie Park | Occupational Therapist | 4960 W Argyle St Apt 2, Chicago, IL 60630-4888 | 2020-10-05 |
| 1447866132 | Lisa Yoensil Yoon Park | Nurse Practitioner | 9204 Esperanza, Irvine, CA 92618-1749 | 2020-09-18 |
| 1356763601 | Lisa Jones Park | Behavioral Analyst | 1510 Sunflower Dr, Missoula, MT 59802-3306 | 2014-01-06 |
| 1972130938 | Lisa Kyoun Park | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Port Jefferson, NY 11777-2190 | 2020-03-26 |
| 1225549082 | Lisa S. Park | Nurse Practitioner | 1301 20th St Ste 150, Santa Monica, CA 90404-2050 | 2017-10-19 |
| 1568857142 | Lisa Park | Surgery | 8700 Beverly Blvd, West Hollywood, CA 90048-1804 | 2015-04-01 |
| 1134484785 | Lisa Park | Optometrist | 3333 Buford Dr, Suite 1030, Buford, GA 30519-4913 | 2012-07-10 |
| 1881950533 | Lisa M Park | Nurse Practitioner | 11729 Roe Ave, Leawood, KS 66211-2605 | 2012-04-06 |
| 1619189115 | Lisa Zito Park | Physical Therapist | 110 Elecia Ln, Foley, AL 36535-8970 | 2007-05-04 |
| 1326269358 | Lisa Lynn Park | Social Worker | 1938 Route 6, Carmel, NY 10512-2311 | 2007-05-01 |
| Street Address |
4400 UNIVERSITY DR STUDENT UNION BUILDING 1, ROOM 2300 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-4422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245210079 | Mary E. Davis | Nurse Practitioner | 4400 University Dr, Ms 2d3, Fairfax, VA 22030-4422 | 2006-01-18 |
| 1326685207 | Yusufu Kamara | Student in an Organized Health Care Education/Training Program | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-10 |
| 1861039752 | Kathy Nguyen | Student in an Organized Health Care Education/Training Program | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-10 |
| 1093352007 | Phung Kim Pham | Specialist/Technologist | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-09 |
| 1083251169 | Hailey Arnold | Student in an Organized Health Care Education/Training Program | 4400 University Dr, Fairfax, VA 22030-4444 | 2019-12-08 |
| 1376180471 | Latoya Marie Lashley | Specialist/Technologist | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-08 |
| 1609413715 | Claudia Talton | Specialist/Technologist | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-08 |
| 1063059152 | Ali Ahmad | Specialist/Technologist | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-08 |
| 1386281467 | Archana Bai Reddy | Student in an Organized Health Care Education/Training Program | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-07 |
| 1861039331 | Janet Rae Stein | Student in an Organized Health Care Education/Training Program | 4400 University Dr, Fairfax, VA 22030-4422 | 2019-12-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578582748 | Wagida A Abdalla | Pediatrics | 4400 University Dr, Msn 2d3, George Mason University, Fairfax, VA 22030-4422 | 2006-07-19 |
| 1376527366 | John T Tsai | Pediatrics | 3650 Joseph Siewick Dr, Suite 101, Fairfax, VA 22033-1710 | 2005-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164869020 | Kyzwana N Caves | Pediatrics | 301 Riverview Ave Ste 3, Norfolk, VA 23510-1065 | 2013-05-31 |
| 1891814844 | East End Pediatrics, P.C. | Pediatrics | 4744 Finlay Street, Richmond, VA 23231 | 2007-03-29 |
| 1013042480 | Privia Medical Group, LLC | Pediatrics | 950 N Glebe Rd, Suite 4000, Arlington, VA 22203-1824 | 2007-02-23 |
| 1821133489 | John Stephen Zachary | Pediatrics | 1521 Huguenot Rd, Suite 101, Midlothian, VA 23113-2426 | 2007-02-21 |
| 1831246891 | William J. Mcaveney | Pediatrics | 221 Randolph St, Mineral, VA 23117-4493 | 2007-01-04 |
| 1619071149 | Irene Townsend | Pediatrics | 3605 Ferncliff Ave Nw, Roanoke, VA 24017-1411 | 2006-09-13 |
| 1447352018 | Richard Vichitr Chusuei | Pediatrics | 8373a Greensboro Dr, Mclean, VA 22102-3529 | 2006-09-02 |
| 1821105412 | Chang-kai Lilly Liu | Pediatrics | 8377a Greensboro Drive, Mclean, VA 22102-3529 | 2006-08-23 |
| 1356457774 | Patty Anne Chitwood | Pediatrics | Schiffert Health Center-virginia Tech, Nccomas Hall, Blacksburg, VA 24060 | 2006-08-21 |
| 1174637888 | Yasmin K. Anez | Pediatrics | 8365a Greensboro Dr, Mclean, VA 22102-3530 | 2006-08-18 |
| Find all providers with the same taxonomy | ||||
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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.