Healthcare Provider Details

I. General information

NPI: 1518845825
Provider Name (Legal Business Name): ELISA KANG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 BALDWIN AVE
SAN MATEO CA
94401-3915
US

IV. Provider business mailing address

280 BALDWIN AVE
SAN MATEO CA
94401-3915
US

V. Phone/Fax

Practice location:
  • Phone: 650-727-6008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: