Provider Demographics
NPI:1467709816
Name:KANG, VALERIE EUNSEOUNG
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:EUNSEOUNG
Last Name:KANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:2083 NEWNAN CROSSING BLVD E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2606
Practice Address - Country:US
Practice Address - Phone:470-241-1408
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2500631174400000X
NY002681-01103K00000X
GA1-22-61264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist