Provider Demographics
NPI:1649834227
Name:KANG, DI (LAC, PHD)
Entity type:Individual
Prefix:
First Name:DI
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35875 PLUMERIA WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-2670
Mailing Address - Country:US
Mailing Address - Phone:510-499-9565
Mailing Address - Fax:
Practice Address - Street 1:2147 MOWRY AVE STE A4
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1724
Practice Address - Country:US
Practice Address - Phone:510-224-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18504171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty