Provider Demographics
NPI:1386122448
Name:KANG, MOSE (FNP)
Entity type:Individual
Prefix:
First Name:MOSE
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 605
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3543
Mailing Address - Country:US
Mailing Address - Phone:310-896-4795
Mailing Address - Fax:
Practice Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 402
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3533
Practice Address - Country:US
Practice Address - Phone:310-639-9363
Practice Address - Fax:310-639-9251
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily