Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G78412 | CA |
Y | 208600000X | Surgeon | G78412 | CA |
N | 2086X0206X | Surgical Oncologist | G78412 | CA |
NPI | 1003870007 |
---|---|
Provider Name | Dr. Sang-Mo Kang |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 12/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0G7841200 | (05) | CA |
G98938 | (02) | CA |