Provider Demographics
NPI:1871505677
Name:HIRANO KANG, MARI CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:CATHERINE
Last Name:HIRANO KANG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3003 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:MEDICAL ARTS BUILDING 2ND FLOOR
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-875-8988
Mailing Address - Fax:813-876-9827
Practice Address - Street 1:6006 49TH ST N
Practice Address - Street 2:SUITE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2148
Practice Address - Country:US
Practice Address - Phone:727-490-5044
Practice Address - Fax:727-490-5043
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102382363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB470ZMedicare PIN
P45301Medicare UPIN