Provider Demographics
NPI:1225472392
Name:FORYOUNG, KENEDY ANDON (MD)
Entity Type:Individual
Prefix:
First Name:KENEDY
Middle Name:ANDON
Last Name:FORYOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3201 JERMANTOWN RD
Mailing Address - Street 2:STE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2885
Mailing Address - Country:US
Mailing Address - Phone:703-667-8600
Mailing Address - Fax:703-667-8601
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-448-4263
Practice Address - Fax:901-448-1248
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2023-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD873972085N0700X, 2085R0202X
TN699722085R0202X
TXU46832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology