Healthcare Provider Details

I. General information

NPI: 1235285909
Provider Name (Legal Business Name): JUNE-KU KANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 AUSTIN CENTER BLVD STE 400
AUSTIN TX
78731-3157
US

IV. Provider business mailing address

6811 AUSTIN CENTER BLVD STE 400
AUSTIN TX
78731-3157
US

V. Phone/Fax

Practice location:
  • Phone: 512-380-9200
  • Fax: 512-380-9201
Mailing address:
  • Phone: 512-380-9200
  • Fax: 512-380-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberN7116
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberN7116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: