Provider Demographics
NPI:1417132572
Name:KANG, JENNIFER ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2216 BUENAVENTURA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3838
Mailing Address - Country:US
Mailing Address - Phone:530-338-0002
Mailing Address - Fax:530-768-1271
Practice Address - Street 1:2216 BUENAVENTURA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3838
Practice Address - Country:US
Practice Address - Phone:530-338-0002
Practice Address - Fax:530-643-7316
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01012207V00000X
NMMD2010-0229207V00000X
CAA125872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology