Healthcare Provider Details

I. General information

NPI: 1477590750
Provider Name (Legal Business Name): NELLIE O. KAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OPITZ BLVD
WOODBRIDGE VA
22191-3311
US

IV. Provider business mailing address

12207 JONATHONS GLEN WAY
HERNDON VA
20170-2352
US

V. Phone/Fax

Practice location:
  • Phone: 703-670-1313
  • Fax:
Mailing address:
  • Phone: 703-670-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101043598
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: