Healthcare Provider Details

I. General information

NPI: 1194903278
Provider Name (Legal Business Name): KANG CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY 115
IRVINE CA
92618-3171
US

IV. Provider business mailing address

113 WATERWORKS WAY 115
IRVINE CA
92618-3171
US

V. Phone/Fax

Practice location:
  • Phone: 949-727-1772
  • Fax: 949-727-1782
Mailing address:
  • Phone: 949-727-1772
  • Fax: 949-727-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27457
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberDC27457
License Number StateCA

VIII. Authorized Official

Name: CHRISTINE SOO HA
Title or Position: OFFICE MANAGER
Credential: DC
Phone: 626-833-4329