MEDICARE: SOO WOONG 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	207R00000X	Internal Medicine Physician	A66630	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164577706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOO WOONG KANG

Provider Business Mailing Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	714-572-6778
Fax Number	:	714-752-6809

Provider Business Practice Location Address
First Line	:	6714 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3410
Country	:	US
Telephone Number	:	147-526-7787
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	04/12/2019

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Directions to “ SOO WOONG KANG ” Practice Location

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