Provider Demographics
NPI:1881865350
Name:KANG, TIM J (LAC)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:J
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:3945 HARRISON ST
Mailing Address - Street 2:#3
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4576
Mailing Address - Country:US
Mailing Address - Phone:415-680-8620
Mailing Address - Fax:
Practice Address - Street 1:2000 DWIGHT WAY
Practice Address - Street 2:SUITE A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2639
Practice Address - Country:US
Practice Address - Phone:415-680-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist