Individual
KENTON WANDASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3800 RESERVOIR RD NW, WASHINGTON, DC 20007-2113
(202) 444-3700
Mailing address
3800 RESERVOIR RD NW, WASHINGTON, DC 20007-2113
(202) 444-3700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/14/2024
Last updated
10/02/2024
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