Provider Demographics
NPI:1134824964
Name:NONG, KELVIN KANG IV (CSW)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:KANG
Last Name:NONG
Suffix:IV
Gender:M
Credentials:CSW
Other - Prefix:MR
Other - First Name:KELVIN
Other - Middle Name:KANG
Other - Last Name:NONG
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:10403 FALLING LEAF CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7507
Mailing Address - Country:US
Mailing Address - Phone:240-610-3654
Mailing Address - Fax:
Practice Address - Street 1:4660 MARTIN LUTHER KING JR AVE SW STE A3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4958
Practice Address - Country:US
Practice Address - Phone:202-318-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator