Healthcare Provider Details

I. General information

NPI: 1003730805
Provider Name (Legal Business Name): KENNY K DOAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 GLENN MITCHELL DR
VIRGINIA BEACH VA
23456-0017
US

IV. Provider business mailing address

2233 ARKLOW RD
VIRGINIA BEACH VA
23456-7741
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-0015
  • Fax:
Mailing address:
  • Phone: 757-705-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217754
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: