Healthcare Provider Details

I. General information

NPI: 1306324850
Provider Name (Legal Business Name): JEOUNG S KANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 200
ORANGE CA
92868
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 200
ORANGE CA
92868-4301
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-1800
  • Fax:
Mailing address:
  • Phone: 714-835-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95009448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: