Provider Demographics
NPI:1508559139
Name:KANG, KATRYNA ELENA GINA (ABOC, NCLEC)
Entity Type:Individual
Prefix:
First Name:KATRYNA
Middle Name:ELENA GINA
Last Name:KANG
Suffix:
Gender:F
Credentials:ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-550 LANIKUHANA AVE
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1783
Mailing Address - Country:US
Mailing Address - Phone:808-623-9200
Mailing Address - Fax:808-623-9677
Practice Address - Street 1:95-550 LANIKUHANA AVE
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1783
Practice Address - Country:US
Practice Address - Phone:808-623-9200
Practice Address - Fax:808-623-9677
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI455156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician