Provider Demographics
NPI:1730475765
Name:KANG, JIN HEE
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:HEE
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 LITTLE RIVER TPKE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2601
Mailing Address - Country:US
Mailing Address - Phone:703-642-1004
Mailing Address - Fax:
Practice Address - Street 1:7601 LITTLE RIVER TPKE STE 100
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2601
Practice Address - Country:US
Practice Address - Phone:703-642-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist