Provider Demographics
NPI:1689692717
Name:KANG, BOMAE NMI (MD)
Entity Type:Individual
Prefix:DR
First Name:BOMAE
Middle Name:NMI
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BOMAE
Other - Middle Name:NMI
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4849 EL CEMONTE AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4482
Mailing Address - Country:US
Mailing Address - Phone:917-683-7448
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-703-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics