Healthcare Provider Details

I. General information

NPI: 1932855434
Provider Name (Legal Business Name): SEUNG HYUN KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TERRACINA BLVD STE 211B
REDLANDS CA
92373-4878
US

IV. Provider business mailing address

245 TERRACINA BLVD STE 211B
REDLANDS CA
92373-4878
US

V. Phone/Fax

Practice location:
  • Phone: 909-307-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95018155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: