MEDICARE: DR. SUNG-HAE KANG PH.D.

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	207SG0203X	Clinical Molecular Genetics Physician	MTP02012971	CA
2	207SC0300X	Clinical Cytogenetics Physician	MTO01010143	CA

General Provider Information

NPI Number	:	1225592793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNG-HAE KANG PH.D.

Provider Business Mailing Address
First Line	:	1010 VETERAN AVE
Second Line	:	WEST MEDICAL BUILDING - CYTOGENETICS LAB (#22-26)
City	:	LOS ANGELES
State	:	CA
Zip	:	90095
Country	:	US
Telephone Number	:	310-825-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVENUE
Second Line	:	DEPARTMENT OF PATHOLOGY & LABORATORY MEDICINE
City	:	LOS ANGELES
State	:	CA
Zip	:	90095
Country	:	US
Telephone Number	:	310-794-2252
Fax Number	:

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

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	01/29/2019

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