Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1538378229 |
---|---|
Provider Name | Mr. Roger Youn Jin Kang |
First Address | Anchorage, AK 99503-1927 |
Second Address | Anchorage, AK 99503-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 19/04/2008 |