Provider Demographics
NPI:1619216975
Name:KANG, SILVIA SOOMI (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:SOOMI
Last Name:KANG
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N BRAESWOOD BLVD
Mailing Address - Street 2:APT 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2845
Mailing Address - Country:US
Mailing Address - Phone:917-584-5494
Mailing Address - Fax:
Practice Address - Street 1:2549 ROY RD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-8604
Practice Address - Country:US
Practice Address - Phone:832-736-9229
Practice Address - Fax:832-739-9229
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0199836OtherNTS