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General NPI Number Information
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NPI Number | 1194390286
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Entity Type | Individual
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Provider Name | RACHEL J KANG BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 3775 VENTURE DR BLDG M STE 101
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City | DULUTH
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State | GA
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Zip | 30096-5217
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Country | US
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Telephone | 470-610-4222
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Fax | 855-648-5902
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Provider Business Mailing Address
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Address Line | 3005 BRECKINRIDGE BLVD STE 230
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City | DULUTH
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State | GA
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Zip | 30096-4978
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Country | US
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Telephone | 678-898-2223
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB563650
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-74119
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License Number State | GA
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