Provider Demographics
NPI:1942645619
Name:KUANG, SIMON (DC)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:KUANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 BERNAL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7157
Mailing Address - Country:US
Mailing Address - Phone:925-232-1058
Mailing Address - Fax:
Practice Address - Street 1:3283 BERNAL AVE STE 107
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7157
Practice Address - Country:US
Practice Address - Phone:925-232-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32572111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician