Provider Demographics
NPI:1225852221
Name:KANG, AIJEAN (FNP)
Entity type:Individual
Prefix:
First Name:AIJEAN
Middle Name:
Last Name:KANG
Suffix:
Gender:U
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W TOWNE RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5511
Mailing Address - Country:US
Mailing Address - Phone:385-308-6823
Mailing Address - Fax:801-945-4720
Practice Address - Street 1:115 W TOWNE RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5511
Practice Address - Country:US
Practice Address - Phone:385-308-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health