Healthcare Provider Details

I. General information

NPI: 1952702458
Provider Name (Legal Business Name): JOHN C. KANG, MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 W OLYMPIC BLVD SUITE 340
LOS ANGELES CA
90006-2484
US

IV. Provider business mailing address

1901 S HOGAN CT
LA HABRA CA
90631-2070
US

V. Phone/Fax

Practice location:
  • Phone: 310-431-7902
  • Fax:
Mailing address:
  • Phone: 310-431-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA84086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA84086
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN CHOONGWHA KANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-431-7902