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NPI Code Detail

MEDICARE: MICHAEL KIM PHENG MD

MEDICARE: MICHAEL KIM PHENG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician101274038VA

General Provider Information

NPI Number : 1386104719
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KIM PHENG MD
Provider Business Mailing Address
First Line : 5460 WESLEYAN DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5460 WESLEYAN DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6906
Country : US
Telephone Number : 757-395-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 01/17/2024

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