Provider Demographics
NPI:1285077487
Name:KANG, JI (LAC)
Entity type:Individual
Prefix:
First Name:JI
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16252 FIELDCREST COURT
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638
Mailing Address - Country:US
Mailing Address - Phone:562-217-2172
Mailing Address - Fax:
Practice Address - Street 1:16252 FIELDCREST CT
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-6506
Practice Address - Country:US
Practice Address - Phone:562-217-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14871171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist