Provider Demographics
NPI:1770519639
Name:DOAN, PHUOC KIM (MD)
Entity type:Individual
Prefix:
First Name:PHUOC
Middle Name:KIM
Last Name:DOAN
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 1:1220 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5048
Mailing Address - Country:US
Mailing Address - Phone:703-243-0250
Mailing Address - Fax:703-243-0148
Practice Address - Street 1:1220 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5048
Practice Address - Country:US
Practice Address - Phone:703-243-0250
Practice Address - Fax:703-243-0148
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006077536Medicaid