Healthcare Provider Details

I. General information

NPI: 1376880971
Provider Name (Legal Business Name): MIN HEE KANG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 TELESTAR CT STE 100
FALLS CHURCH VA
22042-1261
US

IV. Provider business mailing address

2901 TELESTAR CT STE 300
FALLS CHURCH VA
22042-1263
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-9797
  • Fax: 703-591-0829
Mailing address:
  • Phone: 703-591-1688
  • Fax: 703-591-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024171661
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: