Provider Demographics
NPI:1043443039
Name:KANG, JANIS T (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:T
Last Name:KANG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:T
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:98-470 PUAAPIKI STREET
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-927-1565
Mailing Address - Fax:
Practice Address - Street 1:98-470 PUAAPIKI STREET
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-432-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2017-12-21
Deactivation Date:2017-12-05
Deactivation Code:
Reactivation Date:2017-12-13
Provider Licenses
StateLicense IDTaxonomies
HISP-428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0229274OtherHMSA BILLING NUMBER
HI00B0229274OtherHMSA BILLING NUMBER