Provider Demographics
NPI:1831367903
Name:KANG, HELEN HYUN (MD)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:HYUN
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S VIRGIL AVE
Mailing Address - Street 2:STE 505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1416
Mailing Address - Country:US
Mailing Address - Phone:213-388-3550
Mailing Address - Fax:213-928-4287
Practice Address - Street 1:520 S VIRGIL AVE
Practice Address - Street 2:STE 505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1416
Practice Address - Country:US
Practice Address - Phone:213-388-3550
Practice Address - Fax:213-928-4287
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103988208600000X
NYA103988208600000X
NY234563390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740516376Medicaid
CA0A1039880OtherBLUE SHIELD PROVIDER NUMBER
CR961AOtherMEDICARE PTAN
CA1740516376Medicaid
CABA921YMedicare PIN