| Santa Cruz Medical Clinic | |
|
8703 Stonewall Rd 2b Manassas VA 20110-8325 | |
| (703) 361-1955 | |
| (703) 361-3277 |
| Full Name | Santa Cruz Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 8703 Stonewall Rd, Manassas, Virginia |
| Authorized Official Name and Position | Byong K Kang (DR.) |
| Authorized Official Contact | 7033611955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Cruz Medical Clinic 8703 Stonewall Rd 2b Manassas VA 20110-8325 Ph: (703) 361-1955 | Santa Cruz Medical Clinic 8703 Stonewall Rd 2b Manassas VA 20110-8325 Ph: (703) 361-1955 |
| NPI Number | 1013199348 |
|---|---|
| Provider Enumeration Date | 11/28/2007 |
| Last Update Date | 05/15/2008 |
| Medicare PECOS PAC ID | 3971551250 |
|---|---|
| Medicare Enrollment ID | O20050104000744 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013199348 | NPI | - | NPPES |
| C08625 | Other | VA | MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Byong K Kang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295808137 PECOS PAC ID: 4789632068 Enrollment ID: I20050104000766 |
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