Healthcare Provider Details

I. General information

NPI: 1952697773
Provider Name (Legal Business Name): SUNDEEP K KASI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN STE 100
ALEXANDRIA VA
22310-3242
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-7421
  • Fax: 703-313-9422
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-530-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD045044
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD0083796
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101262441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: