Provider Demographics
NPI:1356349260
Name:KANG, HO HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HO
Middle Name:HENRY
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 1:816 W YOSEMITE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4587
Mailing Address - Country:US
Mailing Address - Phone:559-674-7054
Mailing Address - Fax:559-674-4080
Practice Address - Street 1:816 W YOSEMITE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4587
Practice Address - Country:US
Practice Address - Phone:559-674-7054
Practice Address - Fax:559-674-4080
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A464101Medicaid
CAA46410OtherSTATE LICENSE
CAF10685Medicare UPIN
CA00A464100Medicare PIN