Healthcare Provider Details

I. General information

NPI: 1639614779
Provider Name (Legal Business Name): JUNG HO KANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S. CRENSHAW BLVD #304A
LOS ANGELES CA
90019
US

IV. Provider business mailing address

903 S. CRENSHAW BLVD #304A
LOS ANGELES CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 213-393-6327
  • Fax:
Mailing address:
  • Phone: 213-393-6327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: