MEDICARE: MARIA KANG LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1144800939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA KANG LLC

Provider Business Mailing Address
First Line	:	6936 GLORIA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-2426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6936 GLORIA DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-2426
Country	:	US
Telephone Number	:	916-833-1493
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA KANG
Credential	:
Telephone Number	:	916-833-1493

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	08/24/2021

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Directions to “MARIA KANG LLC ” Practice Location

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