Provider Demographics
NPI:1285176941
Name:KANG, SUSANNAH KIM X (LAC)
Entity type:Individual
Prefix:MRS
First Name:SUSANNAH
Middle Name:KIM
Last Name:KANG
Suffix:X
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 S FLOWER ST UNIT 16
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3458
Mailing Address - Country:US
Mailing Address - Phone:714-408-1169
Mailing Address - Fax:714-408-1169
Practice Address - Street 1:9872 CHAPMAN AVE
Practice Address - Street 2:SUITE #114
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2737
Practice Address - Country:US
Practice Address - Phone:714-408-1169
Practice Address - Fax:714-408-1169
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17274171100000X, 173000000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No173000000XOther Service ProvidersLegal Medicine
No174H00000XOther Service ProvidersHealth Educator