Provider Demographics
NPI:1659918589
Name:KANG, HONG (LCO/LP)
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:LCO/LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2685
Mailing Address - Country:US
Mailing Address - Phone:360-416-6505
Mailing Address - Fax:360-416-8241
Practice Address - Street 1:1520 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2685
Practice Address - Country:US
Practice Address - Phone:360-416-6505
Practice Address - Fax:360-416-8241
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS.60990671224P00000X
WAOI.60841234222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist