Provider Demographics
NPI:1013087535
Name:BANKS, KEVIN LUNG-WONG (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LUNG-WONG
Last Name:BANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:SUITE 3G
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1401
Practice Address - Country:US
Practice Address - Phone:614-788-2870
Practice Address - Fax:614-533-0177
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.082920208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2639078Medicaid
OH2639078Medicaid
OH4125301Medicare PIN