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General NPI Number Information
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NPI Number | 1194152371
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Entity Type | Individual
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Provider Name | SORA KANG M.A., PSYD, C.E.A.P.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 09/21/2019
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Provider Practice Location Address
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Address Line | 1503 GRANT RD STE 120
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3293
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Country | US
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Telephone | 810-423-2834
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7703
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City | MENLO PARK
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State | CA
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Zip | 94026-7703
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Country | US
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Telephone |
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY19033
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License Number State | CA
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