Healthcare Provider Details

I. General information

NPI: 1053577478
Provider Name (Legal Business Name): DIANA C KANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

10170 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-9100
  • Fax:
Mailing address:
  • Phone: 858-784-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberA 125083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: