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General NPI Number Information
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NPI Number | 1083966618
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Entity Type | Organization
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Legal Business Name | KANG EASTERN MEDICINE INC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 525 E COLORADO BLVD PENTHOUSE
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City | PASADENA
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State | CA
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Zip | 91101-5226
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Country | US
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Telephone | 818-807-8849
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Fax | 626-389-5479
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Provider Business Mailing Address
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Address Line | 825 CHEHALEM RD
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City | LA CANADA
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State | CA
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Zip | 91011-2502
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Country | US
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Telephone | 818-864-6488
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Fax | 818-864-6488
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MYEONGAE MISCHA KANG
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Credential | LAC, DAOM
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Telephone | 818-807-8849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AC-14622
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License Number State | CA
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