Provider Demographics
NPI:1831298413
Name:CHANG, KI WON (DC FIAMA)
Entity Type:Individual
Prefix:DR
First Name:KI WON
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DC FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004-C LITTLE RIVER TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3201
Mailing Address - Country:US
Mailing Address - Phone:703-916-0303
Mailing Address - Fax:703-658-4881
Practice Address - Street 1:7004-C LITTLE RIVER TURNPIKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3201
Practice Address - Country:US
Practice Address - Phone:703-916-0303
Practice Address - Fax:703-658-4881
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2135960OtherUNITED HEALTH CARE
VA241137OtherKAISER
VA277952OtherANTHEM BC/BS
VA520891OtherNCPPO
VA665262OtherACN GROUP
VA2237420OtherFIRST HEALTH
VAG492-0001OtherCARE FIRST BC/BS
VA665262OtherACN GROUP
VA00B530C94Medicare ID - Type UnspecifiedMEDICARE