Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 20A13638 | CA |
NPI | 1144665571 |
---|---|
Provider Name | Victoria Kang |
First Address | Anaheim, CA 92802-3319 |
Second Address | Santa Ana, CA 92705-3962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 18/08/2017 |