Healthcare Provider Details

I. General information

NPI: 1669531463
Provider Name (Legal Business Name): JOHN CHOONGWHA KANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE HEALTH CARE CONSULTATION CTR; DOCTORS TOWER 1ST FLOOR
LOS ANGELES CA
90027-6005
US

IV. Provider business mailing address

1901 S HOGAN CT
LA HABRA CA
90631-2070
US

V. Phone/Fax

Practice location:
  • Phone: 323-913-4350
  • Fax:
Mailing address:
  • Phone: 310-431-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: