Provider Demographics
NPI:1306358189
Name:BANG, KYONG S (LAC)
Entity Type:Individual
Prefix:
First Name:KYONG
Middle Name:S
Last Name:BANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:KYONG
Other - Middle Name:S
Other - Last Name:BANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHA, KYONGSOON
Mailing Address - Street 1:18940 NEWSOM AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3618
Mailing Address - Country:US
Mailing Address - Phone:408-646-4112
Mailing Address - Fax:
Practice Address - Street 1:333 W MAUDE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4372
Practice Address - Country:US
Practice Address - Phone:408-646-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17916171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist