Provider Demographics
NPI:1740714906
Name:KANG, KI WON (LAC)
Entity type:Individual
Prefix:
First Name:KI WON
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 W 9TH ST
Mailing Address - Street 2:#2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2110
Mailing Address - Country:US
Mailing Address - Phone:213-434-3937
Mailing Address - Fax:
Practice Address - Street 1:2727 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3111
Practice Address - Country:US
Practice Address - Phone:213-738-1974
Practice Address - Fax:213-738-1923
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15972171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist