Provider Demographics
NPI:1982767455
Name:KANG, SUNG-ZOON SAMUEL (DPT)
Entity Type:Individual
Prefix:
First Name:SUNG-ZOON
Middle Name:SAMUEL
Last Name:KANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4084 UNIVERSITY DR
Mailing Address - Street 2:#103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6803
Mailing Address - Country:US
Mailing Address - Phone:703-896-9999
Mailing Address - Fax:703-896-9998
Practice Address - Street 1:4084 UNIVERSITY DR
Practice Address - Street 2:#103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6803
Practice Address - Country:US
Practice Address - Phone:703-896-9999
Practice Address - Fax:703-896-9998
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003128YBKSMedicare PIN