=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619216975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SILVIA SOOMI KANG MS,OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2013
-----------------------------------------------------
Last Update Date | 05/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2549 ROY RD
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77581-8604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-736-9229
-----------------------------------------------------
Fax | 832-739-9229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4620 N BRAESWOOD BLVD APT 250
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77096-2845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-584-5494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 115813
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------