Provider Demographics
NPI:1982837902
Name:KANG, HYO JEONG (L AC)
Entity Type:Individual
Prefix:MRS
First Name:HYO JEONG
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13055 LA JARA ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6156
Mailing Address - Country:US
Mailing Address - Phone:562-809-8652
Mailing Address - Fax:562-809-8652
Practice Address - Street 1:13055 LA JARA ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6156
Practice Address - Country:US
Practice Address - Phone:562-809-8652
Practice Address - Fax:562-809-8652
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12666171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist