Provider Demographics
NPI:1669870473
Name:JOHN C. KANG, MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOHN C. KANG, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHOONGWHA
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-373-1222
Mailing Address - Street 1:3130 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2484
Mailing Address - Country:US
Mailing Address - Phone:323-373-1222
Mailing Address - Fax:323-373-1555
Practice Address - Street 1:1401 S BROOKHURST RD
Practice Address - Street 2:SUITE 111
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4471
Practice Address - Country:US
Practice Address - Phone:714-626-0301
Practice Address - Fax:323-373-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84086208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty