Provider Demographics
NPI:1841990231
Name:POWER, KYONG CHANG
Entity type:Individual
Prefix:MRS
First Name:KYONG
Middle Name:CHANG
Last Name:POWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 PERCY STRICKLAND RD
Mailing Address - Street 2:
Mailing Address - City:GODWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28344-8476
Mailing Address - Country:US
Mailing Address - Phone:910-705-2483
Mailing Address - Fax:
Practice Address - Street 1:6116 PERCY STRICKLAND RD
Practice Address - Street 2:
Practice Address - City:GODWIN
Practice Address - State:NC
Practice Address - Zip Code:28344-8476
Practice Address - Country:US
Practice Address - Phone:910-705-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPOWE-5291Z2084P0800X
NC5018451363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry