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General NPI Number Information
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NPI Number | 1285107714
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Entity Type | Individual
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Provider Name | KWANG HEE ALEXANDER JOHNG CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 804 22ND AVE
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City | KEARNEY
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State | NE
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Zip | 68845-2206
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Country | US
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Telephone | 308-455-3600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | KEARNEY
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State | NE
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Zip | 68848-0099
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Country | US
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Telephone | 308-224-2062
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Fax | 888-974-5962
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101514
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License Number State | NE
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