Provider Demographics
NPI:1376614552
Name:KANG, KIJUNG BAE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIJUNG
Middle Name:BAE
Last Name:KANG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 MIDRA DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3560
Mailing Address - Country:US
Mailing Address - Phone:240-463-8965
Mailing Address - Fax:
Practice Address - Street 1:1620 ELTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1740
Practice Address - Country:US
Practice Address - Phone:301-439-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program