Provider Demographics
NPI:1942219944
Name:OU, HUNG KANG (MD)
Entity Type:Individual
Prefix:DR
First Name:HUNG KANG
Middle Name:
Last Name:OU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:H K
Other - Last Name:OU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4195 CHINO HILLS PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2618
Mailing Address - Country:US
Mailing Address - Phone:909-597-7817
Mailing Address - Fax:909-597-7984
Practice Address - Street 1:4195 CHINO HILLS PKWY STE H
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-2618
Practice Address - Country:US
Practice Address - Phone:909-597-7817
Practice Address - Fax:909-597-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A415111Medicaid
CAA29397Medicare UPIN
CA00A415111Medicare PIN
CA00A415111Medicaid