Provider Demographics
NPI:1639935646
Name:TANG, KENNETH ALDRIC (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALDRIC
Last Name:TANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 LINCOLNSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2520
Mailing Address - Country:US
Mailing Address - Phone:571-533-8028
Mailing Address - Fax:
Practice Address - Street 1:2311 M ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1495
Practice Address - Country:US
Practice Address - Phone:202-296-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401493511223P0300X
DC301903261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty