Provider Demographics
NPI:1295808137
Name:KANG, BYONG KUK (MD)
Entity type:Individual
Prefix:DR
First Name:BYONG
Middle Name:KUK
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8703 STONEWALL RD
Mailing Address - Street 2:2-B
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8325
Mailing Address - Country:US
Mailing Address - Phone:703-361-1955
Mailing Address - Fax:703-361-3277
Practice Address - Street 1:8703 STONEWALL RD
Practice Address - Street 2:2-B
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8325
Practice Address - Country:US
Practice Address - Phone:703-361-1955
Practice Address - Fax:703-361-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH24042Medicare UPIN
VA00V232S25Medicare ID - Type Unspecified