MEDICARE: KWANGYO KANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT292759	CA

General Provider Information

NPI Number	:	1134634603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWANGYO KANG

Provider Business Mailing Address
First Line	:	25301 CABOT RD STE 111
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5511
Country	:	US
Telephone Number	:	949-691-9795
Fax Number	:	949-763-3070

Provider Business Practice Location Address
First Line	:	25301 CABOT RD STE 111
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5511
Country	:	US
Telephone Number	:	949-691-9795
Fax Number	:	949-763-3070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	07/28/2023

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Directions to “ KWANGYO KANG ” Practice Location

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