Provider Demographics
NPI:1710068846
Name:KAHNG, MOSES (DPM)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:
Last Name:KAHNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 W. 6TH ST # STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3048
Mailing Address - Country:US
Mailing Address - Phone:213-365-1000
Mailing Address - Fax:
Practice Address - Street 1:3663 W 6TH ST STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3048
Practice Address - Country:US
Practice Address - Phone:213-365-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0570650001Medicare NSC