Provider Demographics
NPI:1336257070
Name:KANG, DANIEL WON (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WON
Last Name:KANG
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:WON
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,MPH
Mailing Address - Street 1:1245 16TH ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1235
Mailing Address - Country:US
Mailing Address - Phone:310-315-8920
Mailing Address - Fax:310-315-8922
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-315-8920
Practice Address - Fax:310-315-8922
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12952207R00000X
CAA109210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine