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NPI Code Detail

MEDICARE: SOWAN KANG PHD

MEDICARE: SOWAN KANG PHD
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
1103TC0700XClinical Psychologist0810008783VA

General Provider Information

NPI Number : 1255050001
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOWAN KANG PHD
Provider Business Mailing Address
First Line : 1100 WILFORD HALL LOOP
Second Line :
City : JBSA LACKLAND
State : TX
Zip : 78236-5638
Country : US
Telephone Number : 210-292-1602
Fax Number :
Provider Business Practice Location Address
First Line : 1515 TRUEMPER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78236-5583
Country : US
Telephone Number : 509-919-1327
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2022
Last Update Date : 05/28/2025

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