MEDICARE: SOOK JUNG KANG F.N.P.

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	363LF0000X	Family Nurse Practitioner	720747	TX

General Provider Information

NPI Number	:	1629398953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOK JUNG KANG F.N.P.

Provider Business Mailing Address
First Line	:	1636 W 6TH ST APT D
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-5054
Country	:	US
Telephone Number	:	512-786-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 SHOAL CREEK BLVD # 4-107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	512-451-4488
Fax Number	:	512-453-2707

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	06/09/2010

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