Provider Demographics
NPI:1528563574
Name:KANG, GRACE (DO)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-6260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:573-250-7287
Practice Address - Street 1:2001 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-6260
Practice Address - Country:US
Practice Address - Phone:936-633-5632
Practice Address - Fax:936-634-8601
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS40032084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry