Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN302270/NPF10214 | CA |
NPI | 1013092832 |
---|---|
Provider Name | Ms. Patricia Lynne Kang |
First Address | Sacramento, CA 95823-4671 |
Second Address | Sacramento, CA 95823-4671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S81065 | (02) | CA |