Provider Demographics
NPI:1154472280
Name:KANG, LISA NAERI (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:NAERI
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:950 STOCKTON ST
Mailing Address - Street 2:SUITE 388
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-296-9302
Mailing Address - Fax:415-296-9361
Practice Address - Street 1:950 STOCKTON ST
Practice Address - Street 2:SUITE 388
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-296-9302
Practice Address - Fax:415-296-9361
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55903208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559030Medicaid
H06407Medicare UPIN
CA00A559030Medicaid