MEDICARE: SHELLA KANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	171M00000X	Case Manager/Care Coordinator
3	374U00000X	Home Health Aide	HHA2200004169	DC

General Provider Information

NPI Number	:	1053145763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLA KANG

Provider Business Mailing Address
First Line	:	1818 NEW YORK AVE NE # DC110
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1848
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 NEW YORK AVE NE # DC110
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1848
Country	:	US
Telephone Number	:	202-489-0615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	06/19/2026

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Directions to “ SHELLA KANG ” Practice Location

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