Provider Demographics
NPI:1669522264
Name:KU, HONG KANG (OD)
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:KANG
Last Name:KU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22215 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3359
Mailing Address - Country:US
Mailing Address - Phone:310-830-2201
Mailing Address - Fax:310-830-2241
Practice Address - Street 1:22215 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3359
Practice Address - Country:US
Practice Address - Phone:310-830-2201
Practice Address - Fax:310-830-2241
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12786T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB226809Medicare PIN