Provider Demographics
NPI:1225463854
Name:KANG, LESA (OD)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3085 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2916
Mailing Address - Country:US
Mailing Address - Phone:805-583-3950
Mailing Address - Fax:805-584-2477
Practice Address - Street 1:3085 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2916
Practice Address - Country:US
Practice Address - Phone:805-648-3085
Practice Address - Fax:805-648-7027
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14744 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist