Provider Demographics
NPI:1376131508
Name:KANG, YOUNG-HEE
Entity Type:Individual
Prefix:MS
First Name:YOUNG-HEE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 TRINITY PKWY APT 364
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2448
Mailing Address - Country:US
Mailing Address - Phone:703-405-3090
Mailing Address - Fax:
Practice Address - Street 1:5865 TRINITY PKWY APT 364
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-2448
Practice Address - Country:US
Practice Address - Phone:703-405-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0656108987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health