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General NPI Number Information
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NPI Number | 1467820571
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Entity Type | Individual
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Provider Name | JONGHAN KANG L.AC., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 1321 N HARBOR BLVD STE 205
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City | FULLERTON
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State | CA
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Zip | 92835
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Country | US
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Telephone | 866-553-4515
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Fax | 860-631-2785
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Provider Business Mailing Address
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Address Line | 1321 N HARBOR BLVD STE 205
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City | FULLERTON
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State | CA
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Zip | 92835-4130
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Country | US
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Telephone | 866-553-4115
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Fax | 860-631-2785
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 56189
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16982
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License Number State | CA
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