Healthcare Provider Details

I. General information

NPI: 1659432870
Provider Name (Legal Business Name): DAVID K KAHNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 3RD ST SUITE 102
LOS ANGELES CA
90020-3450
US

IV. Provider business mailing address

4220 W 3RD ST SUITE 102
LOS ANGELES CA
90020-3450
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-4800
  • Fax: 213-384-4811
Mailing address:
  • Phone: 213-384-4800
  • Fax: 213-384-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA75005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: