Healthcare Provider Details

I. General information

NPI: 1952175432
Provider Name (Legal Business Name): TYLER KANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N JUAREZ ST
MONTEBELLO CA
90640-2522
US

IV. Provider business mailing address

717 N JUAREZ ST
MONTEBELLO CA
90640-2522
US

V. Phone/Fax

Practice location:
  • Phone: 323-695-3800
  • Fax:
Mailing address:
  • Phone: 323-695-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: