Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1063846772 |
---|---|
Provider Name | Stephanie Kang |
First Address | Los Angeles, CA 90027-5969 |
Second Address | Los Angeles, CA 90027-5969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 15/12/2021 |