Provider Demographics
NPI:1639509979
Name:KANG, EUN (LAC)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:16303 S WESTERN AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4674
Mailing Address - Country:US
Mailing Address - Phone:310-538-9917
Mailing Address - Fax:310-538-9918
Practice Address - Street 1:16303 S WESTERN AVE STE 9
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4674
Practice Address - Country:US
Practice Address - Phone:310-538-9917
Practice Address - Fax:310-538-9918
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 15587171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist