Provider Demographics
NPI:1245589969
Name:KANG, JUNBOUM (MSOM)
Entity Type:Individual
Prefix:
First Name:JUNBOUM
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 YGNACIO VALLEY RD.
Mailing Address - Street 2:BUILDING E, SUITE 204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3383
Mailing Address - Country:US
Mailing Address - Phone:925-280-4599
Mailing Address - Fax:
Practice Address - Street 1:2121 YGNACIO VALLEY RD.
Practice Address - Street 2:BUILDING E, SUITE 204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3383
Practice Address - Country:US
Practice Address - Phone:925-280-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist