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General NPI Number Information
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NPI Number | 1942607015
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Entity Type | Individual
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Provider Name | SHINJE KANG PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-2252
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Fax | 253-968-1586
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Provider Business Mailing Address
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Address Line | WH3S9A 549 HC/BAACH, UNIT 15245
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City | APO
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State | AP
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Zip | 96271
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Country | KR
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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