Provider Demographics
NPI:1598712150
Name:MY HOA KAAS DPM PC
Entity Type:Organization
Organization Name:MY HOA KAAS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MY HOA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-205-0770
Mailing Address - Street 1:2826 OLD LEE HIGHWAY #220
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4348
Mailing Address - Country:US
Mailing Address - Phone:703-205-0770
Mailing Address - Fax:703-205-0771
Practice Address - Street 1:2826 OLD LEE HIGHWAY #220
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:703-205-0770
Practice Address - Fax:703-205-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1PD0031143213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02365Medicare PIN