Provider Demographics
NPI:1609927466
Name:KANG, CATHARINA H (PHD)
Entity Type:Individual
Prefix:
First Name:CATHARINA
Middle Name:H
Last Name:KANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 OBERLIN DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4717
Mailing Address - Country:US
Mailing Address - Phone:435-512-9912
Mailing Address - Fax:
Practice Address - Street 1:5755 OBERLIN DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4717
Practice Address - Country:US
Practice Address - Phone:435-512-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3539922501103T00000X
UT353992-2501103T00000X
CAPSY31514103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT006382006Medicare ID - Type Unspecified