Provider Demographics
NPI:1457430159
Name:KANG, DANIEL SI JUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SI JUNG
Last Name:KANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17050 CHATSWORTH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5888
Mailing Address - Country:US
Mailing Address - Phone:818-832-0897
Mailing Address - Fax:818-832-3076
Practice Address - Street 1:17050 CHATSWORTH ST STE 115
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5888
Practice Address - Country:US
Practice Address - Phone:818-832-0897
Practice Address - Fax:818-832-3076
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98725Medicare UPIN
CADC27243Medicare ID - Type Unspecified