Provider Demographics
NPI:1780704775
Name:KANG, KOON JA (LAC)
Entity type:Individual
Prefix:MRS
First Name:KOON
Middle Name:JA
Last Name:KANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:JA
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:12231 POMERING RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3317
Mailing Address - Country:US
Mailing Address - Phone:562-923-7229
Mailing Address - Fax:562-923-7229
Practice Address - Street 1:3711 LONG BEACH BLVD
Practice Address - Street 2:SUITE#200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3315
Practice Address - Country:US
Practice Address - Phone:562-659-4136
Practice Address - Fax:562-428-1409
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5966171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist