Provider Demographics
NPI:1013280288
Name:KANG, SARAH J (FNP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:J
Last Name:KANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOO
Other - Middle Name:YON
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 791128
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:555 HERNDON PKWY
Practice Address - Street 2:# 100
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-481-1505
Practice Address - Fax:703-742-8793
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00532Medicare PIN