Healthcare Provider Details

I. General information

NPI: 1336788256
Provider Name (Legal Business Name): SERENA KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 THE ALAMEDA
SAN JOSE CA
95126-1726
US

IV. Provider business mailing address

493 LA SCENA PL
SAN JOSE CA
95128-5157
US

V. Phone/Fax

Practice location:
  • Phone: 408-335-8304
  • Fax:
Mailing address:
  • Phone: 408-402-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: