Provider Demographics
NPI:1689078917
Name:KANG, SANG MOOK
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:MOOK
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 W CHAPMAN AVE
Mailing Address - Street 2:APT. 2241
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1440 S ANAHEIM BLVD
Practice Address - Street 2:#G-1
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6213
Practice Address - Country:US
Practice Address - Phone:949-903-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist