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General NPI Number Information
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NPI Number | 1851917264
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Entity Type | Individual
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Provider Name | SIMON MOONKOO KANG NP
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Gender | Male
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1825 4TH ST RM 5B
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2350
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Country | US
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Telephone | 415-514-3147
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Fax |
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0002
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Country | US
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Telephone | 507-284-2511
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7472
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95037156
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 7472
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License Number State | MN
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