Provider Demographics
NPI:1710428909
Name:KANG, YIRYE (LAC)
Entity Type:Individual
Prefix:
First Name:YIRYE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:10580 TRIPLE CROWN LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5270
Mailing Address - Country:US
Mailing Address - Phone:213-841-2425
Mailing Address - Fax:
Practice Address - Street 1:28924 S WESTERN AVE STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0823
Practice Address - Country:US
Practice Address - Phone:213-841-2425
Practice Address - Fax:213-403-4545
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC16637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist