Provider Demographics
NPI:1326502196
Name:KANG, MYUNG (NP-C)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W MOUNTAIN VIEW AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-9213
Mailing Address - Country:US
Mailing Address - Phone:714-797-7770
Mailing Address - Fax:
Practice Address - Street 1:505 S VIRGIL AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1415
Practice Address - Country:US
Practice Address - Phone:213-739-0007
Practice Address - Fax:213-739-0011
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010494363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology