Provider Demographics
NPI:1104048438
Name:PARK, JESOON HELMSLEY (LAC)
Entity type:Individual
Prefix:MR
First Name:JESOON HELMSLEY
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:HELMSLEY
Other - Middle Name:JE SOON
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2102 GALLOWS RD # D
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3960
Mailing Address - Country:US
Mailing Address - Phone:703-338-1400
Mailing Address - Fax:703-506-9111
Practice Address - Street 1:2102 GALLOWS RD # D
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3960
Practice Address - Country:US
Practice Address - Phone:703-338-1400
Practice Address - Fax:703-506-9111
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist