Healthcare Provider Details

I. General information

NPI: 1699380667
Provider Name (Legal Business Name): SCARLETT SEYEON KANG MSN, PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SE YEON KANG

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 AUTO CENTER DR
PALMDALE CA
93551-4599
US

IV. Provider business mailing address

14126 MARQUESAS WAY APT 3220
MARINA DEL REY CA
90292-7363
US

V. Phone/Fax

Practice location:
  • Phone: 661-267-6876
  • Fax:
Mailing address:
  • Phone: 703-888-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017605
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95017605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: