Provider Demographics
NPI:1891561502
Name:KANG, GINA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 NAPLES ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3819
Mailing Address - Country:US
Mailing Address - Phone:213-369-0533
Mailing Address - Fax:
Practice Address - Street 1:1020 TIERRA DEL REY # A-1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7886
Practice Address - Country:US
Practice Address - Phone:619-585-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25561225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist