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NPI Code Detail

MEDICARE: SOO KANG PMHNP

MEDICARE: SOO KANG PMHNP
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
1363L00000XNurse Practitioner95016830CA

General Provider Information

NPI Number : 1356983670
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOO KANG PMHNP
Provider Business Mailing Address
First Line : 7273 14TH AVE STE 120B
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-3500
Country : US
Telephone Number : 916-383-6784
Fax Number :
Provider Business Practice Location Address
First Line : 510 PLAZA DR STE 170
Second Line :
City : FOLSOM
State : CA
Zip : 95630-4790
Country : US
Telephone Number : 916-351-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2019
Last Update Date : 04/13/2026

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Directions to “ SOO KANG PMHNP” Practice Location

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