Healthcare Provider Details

I. General information

NPI: 1720192917
Provider Name (Legal Business Name): EUGENE KAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5762 BOLSA AVE. SUITE 107
HUNTINGTON BEACH CA
92649-1172
US

IV. Provider business mailing address

5762 BOLSA AVE. SUITE 107
HUNTINGTON BEACH CA
92649-1172
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-0362
  • Fax: 714-893-3267
Mailing address:
  • Phone: 714-898-0362
  • Fax: 714-893-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS14811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: