Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A114952 | CA |
N | 111NI0900X | Internist | A114952 | CA |
N | 208000000X | Pediatrician | A114952 | CA |
NPI | 1003045600 |
---|---|
Provider Name | Mina Rim Kang |
First Address | Santa Monica, CA 90404-2303 |
Second Address | Santa Monica, CA 90404-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2009 |
Last Update Date | 15/04/2021 |