Provider Demographics
NPI:1740999457
Name:KANG, SUNGKOO (L AC)
Entity type:Individual
Prefix:
First Name:SUNGKOO
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 LINCOLN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4615
Mailing Address - Country:US
Mailing Address - Phone:951-805-9262
Mailing Address - Fax:
Practice Address - Street 1:7151 LINCOLN AVE STE K
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4615
Practice Address - Country:US
Practice Address - Phone:714-952-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty