Healthcare Provider Details

I. General information

NPI: 1578478517
Provider Name (Legal Business Name): KA NGAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE
NEWARK NJ
07102-1909
US

IV. Provider business mailing address

765 ROUTE 70 E BLDG A-100
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-797-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15614500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: