Healthcare Provider Details

I. General information

NPI: 1578794129
Provider Name (Legal Business Name): KRIS S KANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W. LAS POSITAS RD.
LIVERMORE CA
94551
US

IV. Provider business mailing address

2700 W. LAS POSITAS BLVD.
LIVERMORE CA
94551
US

V. Phone/Fax

Practice location:
  • Phone: 925-243-1551
  • Fax:
Mailing address:
  • Phone: 925-243-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: