MEDICARE: SOOKJA 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	163W00000X	Registered Nurse	799629	TX

General Provider Information

NPI Number	:	1851222897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOOKJA KANG

Provider Business Mailing Address
First Line	:	4553 MATTIE ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 MATTIE ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-5474
Country	:	US
Telephone Number	:	512-422-2665
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ SOOKJA KANG ” Practice Location

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