Provider Demographics
NPI:1467820571
Name:KANG, JONGHAN (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:JONGHAN
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 N HARBOR BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4130
Mailing Address - Country:US
Mailing Address - Phone:866-553-4115
Mailing Address - Fax:860-631-2785
Practice Address - Street 1:1321 N HARBOR BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:866-553-4515
Practice Address - Fax:860-631-2785
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56189225700000X
CA16982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist