Healthcare Provider Details

I. General information

NPI: 1235615741
Provider Name (Legal Business Name): RICHARD J. KANG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD
NORTHRIDGE CA
91325-4105
US

IV. Provider business mailing address

9227 RESEDA BLVD # 130
NORTHRIDGE CA
91324-3137
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-5349
  • Fax: 818-885-5448
Mailing address:
  • Phone: 818-419-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83965
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA83965
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD J KANG
Title or Position: PRESIDENT
Credential: MD
Phone: 818-419-5627