Healthcare Provider Details

I. General information

NPI: 1205683380
Provider Name (Legal Business Name): KYUNG HEE KANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 COURT ST
REDDING CA
96001-2531
US

IV. Provider business mailing address

PO BOX 994190
REDDING CA
96099-4190
US

V. Phone/Fax

Practice location:
  • Phone: 530-243-8667
  • Fax: 530-243-8742
Mailing address:
  • Phone: 530-243-8667
  • Fax: 530-243-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: