Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY20310 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20310 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY20310 | CA |
NPI | 1689744005 |
---|---|
Provider Name | Eileen Swan Kang |
First Address | Irvine, CA 92619 |
Second Address | Irvine, CA 92618-1040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 14/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q62020 | (02) | CA |