Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | AMFT186056 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023558558 |
---|---|
Provider Name | Sara Kang |
First Address | Lancaster, CA 93534-3443 |
Second Address | Lancaster, CA 93534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2017 |
Last Update Date | 29/07/2019 |