Provider Demographics
NPI:1982636288
Name:KANG, JOSEPH I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:I
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9220
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90608-9220
Mailing Address - Country:US
Mailing Address - Phone:562-249-8344
Mailing Address - Fax:
Practice Address - Street 1:7941 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2414
Practice Address - Country:US
Practice Address - Phone:562-360-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34033174400000X, 207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003000811Medicaid
CA1982636288Medicaid
CA00G340334Medicaid
CA00G340332Medicaid