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General NPI Number Information
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NPI Number | 1699841148
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Entity Type | Organization
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Legal Business Name | KAZUKO K PRICE MD LTD
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4701 KENMORE AVENUE SUITE 118
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1248
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Country | US
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Telephone | 703-751-3344
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Fax | 703-751-3345
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Provider Business Mailing Address
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Address Line | 4701 KENMORE AVENUE SUITE 118
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1248
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Country | US
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Telephone | 703-751-3344
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Fax | 703-751-3345
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAZUKO KUKITA PRICE
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Credential | MD
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Telephone | 703-751-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101015073
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License Number State | VA
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