Provider Demographics
NPI:1881082394
Name:KANG, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 S CATALINA ST
Mailing Address - Street 2:APT 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2270
Mailing Address - Country:US
Mailing Address - Phone:909-633-2074
Mailing Address - Fax:
Practice Address - Street 1:540 S CATALINA ST
Practice Address - Street 2:APT 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2270
Practice Address - Country:US
Practice Address - Phone:909-633-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist