Provider Demographics
NPI:1679699961
Name:KANG, GLORIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:C
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3604 WEDGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 CAROL SUE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-4167
Practice Address - Country:US
Practice Address - Phone:504-391-8290
Practice Address - Fax:504-391-8291
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025463208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88083Medicare UPIN