Healthcare Provider Details

I. General information

NPI: 1679078877
Provider Name (Legal Business Name): TONY KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 106
LANSDOWNE VA
20176-8470
US

IV. Provider business mailing address

500 J CLYDE MORRIS BLVD FL 2
NEWPORT NEWS VA
23601-1929
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9633
  • Fax: 703-723-9772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101278086
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: