Provider Demographics
NPI:1467602953
Name:LU, KANG (MD)
Entity Type:Individual
Prefix:
First Name:KANG
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4551 JEFFERSON POINTE LN
Mailing Address - Street 2:APARTMENT # 5.
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1478
Mailing Address - Country:US
Mailing Address - Phone:253-223-6793
Mailing Address - Fax:
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:KENNER ARMY HEALTH CLINIC
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1100192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFR791ZMedicare PIN