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NPI Code Detail

MEDICARE: KELVIN KANG NONG IV CSW

MEDICARE: KELVIN KANG NONG IV CSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1134824964
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELVIN KANG NONG IV CSW
Provider Business Mailing Address
First Line : 10403 FALLING LEAF CT
Second Line :
City : SPRINGDALE
State : MD
Zip : 20774-7507
Country : US
Telephone Number : 240-610-3654
Fax Number :
Provider Business Practice Location Address
First Line : 4660 MARTIN LUTHER KING JR AVE SW STE A3
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-4958
Country : US
Telephone Number : 202-318-0179
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2023
Last Update Date : 05/06/2024

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