Healthcare Provider Details

I. General information

NPI: 1518530245
Provider Name (Legal Business Name): YOUNGTAE KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST
LOS ANGELES CA
90020-5105
US

IV. Provider business mailing address

3671 W 6TH ST # 200
LOS ANGELES CA
90020-3894
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone: 213-235-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMDR-8086
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA192735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: