Healthcare Provider Details

I. General information

NPI: 1942797543
Provider Name (Legal Business Name): RENEE LUCERO KANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE NICOLE LUCERO

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CLOCK TOWER PL STE 250
CARMEL CA
93923-8775
US

IV. Provider business mailing address

100 CLOCK TOWER PL STE 250
CARMEL CA
93923-8775
US

V. Phone/Fax

Practice location:
  • Phone: 831-308-4570
  • Fax: 831-222-1001
Mailing address:
  • Phone: 831-308-4570
  • Fax: 831-222-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A17953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: