Healthcare Provider Details

I. General information

NPI: 1982923348
Provider Name (Legal Business Name): KYOUNGSANG KANG L. AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 YGNACIO VALLEY RD SUITE 112
WALNUT CREEK CA
94598-3190
US

IV. Provider business mailing address

1776 YGNACIO VALLEY RD SUITE 112
WALNUT CREEK CA
94598-3190
US

V. Phone/Fax

Practice location:
  • Phone: 925-478-8550
  • Fax: 925-478-4877
Mailing address:
  • Phone: 925-478-8550
  • Fax: 925-478-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: