Provider Demographics
NPI:1407350127
Name:KANG, EUNJIN (PT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:EUNJIN
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 EL CAMINO REAL STE J27
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1048
Mailing Address - Country:US
Mailing Address - Phone:858-847-2025
Mailing Address - Fax:
Practice Address - Street 1:12925 EL CAMINO REAL STE J27
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1048
Practice Address - Country:US
Practice Address - Phone:858-847-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist