MEDICARE: KAGNA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1861951378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAGNA KANG

Provider Business Mailing Address
First Line	:	140 S FLOWER ST STE 100
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3467
Country	:	US
Telephone Number	:	714-683-5876
Fax Number	:

Provider Business Practice Location Address
First Line	:	39899 BALENTINE DR STE 128
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-5361
Country	:	US
Telephone Number	:	650-931-6300
Fax Number	:

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

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	02/09/2023

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Directions to “ KAGNA KANG ” Practice Location

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