Healthcare Provider Details

I. General information

NPI: 1710963871
Provider Name (Legal Business Name): JEFFREY M KANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ARH LN
LOW MOOR VA
24457-5702
US

IV. Provider business mailing address

1 ARH LN
LOW MOOR VA
24457-5702
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-7181
  • Fax: 540-862-0034
Mailing address:
  • Phone: 540-862-7181
  • Fax: 540-862-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101235503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: