Provider Demographics
NPI:1598486987
Name:KANG, ALEX MYOUNGWOO (LAC)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:MYOUNGWOO
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CYPRESS POINT PL
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1285
Mailing Address - Country:US
Mailing Address - Phone:484-557-9500
Mailing Address - Fax:
Practice Address - Street 1:204 CYPRESS POINT PL
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1285
Practice Address - Country:US
Practice Address - Phone:484-557-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist