Provider Demographics
NPI:1700974706
Name:KANG, LAURA JEAN (MS , IMF)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:KANG
Suffix:
Gender:F
Credentials:MS , IMF
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:SLOWEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 MCLEAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620
Mailing Address - Country:US
Mailing Address - Phone:949-636-5487
Mailing Address - Fax:
Practice Address - Street 1:1666 N. MAIN STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-704-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist