Provider Demographics
NPI:1720198179
Name:KANG, LAURA HAEKYOUNG (APN,C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:HAEKYOUNG
Last Name:KANG
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CECILIA DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4605
Mailing Address - Country:US
Mailing Address - Phone:973-872-8879
Mailing Address - Fax:
Practice Address - Street 1:424 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3212
Practice Address - Country:US
Practice Address - Phone:973-674-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450358163W00000X
NJ26NR08414400163W00000X
NY405060363LP0808X
NJ26NJ00107600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse