Healthcare Provider Details

I. General information

NPI: 1659794147
Provider Name (Legal Business Name): JANE KANG, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 N MOPAC EXPY WESTPARK BUILDING 2 SUITE 200
AUSTIN TX
78759-8837
US

IV. Provider business mailing address

8807 SILVERHILL CV
AUSTIN TX
78759-7415
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-2332
  • Fax:
Mailing address:
  • Phone: 713-416-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberL5782
License Number StateTX

VIII. Authorized Official

Name: JANE KANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 713-416-5264