Provider Demographics
NPI:1013740281
Name:LI KUANG CRNA INC., A PROFESSIONAL NURSING ANESTHESIA CORPORATION
Entity type:Organization
Organization Name:LI KUANG CRNA INC., A PROFESSIONAL NURSING ANESTHESIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-628-0675
Mailing Address - Street 1:846 N MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1573
Mailing Address - Country:US
Mailing Address - Phone:850-628-0675
Mailing Address - Fax:
Practice Address - Street 1:43944 15TH ST W STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5207
Practice Address - Country:US
Practice Address - Phone:661-579-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty