Healthcare Provider Details

I. General information

NPI: 1013092832
Provider Name (Legal Business Name): PATRICIA LYNNE KANG GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD ELDERCARE ADULT MEDICINE F
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6600 BRUCEVILLE RD ELDERCARE ADULT MEDICINE F
SACRAMENTO CA
95823-4671
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-6862
  • Fax: 916-973-6682
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN302270/NPF10214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: