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General NPI Number Information
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NPI Number | 1023356169
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Entity Type | Individual
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Provider Name | KC BRYN LANG PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1200 W TABOR RD FL 4
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3019
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Country | US
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Telephone | 215-456-3815
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Fax | 215-456-6803
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Provider Business Mailing Address
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Address Line | 101 E OLNEY AVE STE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2470
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Country | US
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Telephone | 154-561-8252
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Fax | 215-456-5926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA056031
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License Number State | PA
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