Provider Demographics
NPI:1356613459
Name:KANG, SOYEON
Entity type:Individual
Prefix:DR
First Name:SOYEON
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 STONELAKE BLVD
Mailing Address - Street 2:APT.735
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5940
Mailing Address - Country:US
Mailing Address - Phone:512-626-8316
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY STA
Practice Address - Street 2:D5300, DEPT OF SPECIAL ED
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-0803
Practice Address - Country:US
Practice Address - Phone:512-232-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1107476103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHCPE107137OtherCPH AND ASSOCIATES