Provider Demographics
NPI:1578921169
Name:KANG, CHRISTIANA (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ADAMS PL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7456
Mailing Address - Country:US
Mailing Address - Phone:617-302-4194
Mailing Address - Fax:
Practice Address - Street 1:922 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1256
Practice Address - Country:US
Practice Address - Phone:781-400-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2288170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily