Healthcare Provider Details

I. General information

NPI: 1801529375
Provider Name (Legal Business Name): STEVE HEEWON KANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 DOLCI
IRVINE CA
92602-1880
US

IV. Provider business mailing address

128 DOLCI
IRVINE CA
92602-1880
US

V. Phone/Fax

Practice location:
  • Phone: 949-560-0903
  • Fax:
Mailing address:
  • Phone: 949-560-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA64680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: