Healthcare Provider Details

I. General information

NPI: 1801464896
Provider Name (Legal Business Name): JANE JINA KANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6670 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

6670 ALTON PKWY
IRVINE CA
92618-3734
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A22242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: