Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401006989 | VA |
Y | 213EG0000X | General Practice | 0401006989 | VA |
NPI | 1003053984 |
---|---|
Provider Name | Dr. Eul-Mo Kang |
First Address | Annandale, VA 22003 |
Second Address | Annandale, VA 22003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 14/01/2009 |