Provider Demographics
NPI:1447554787
Name:KANG, HYUNGBUM
Entity type:Individual
Prefix:
First Name:HYUNGBUM
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B CO. 304TH SIGNAL BN.
Mailing Address - Street 2:BOX 115
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:B CO. 304TH SIGNAL BN.
Practice Address - Street 2:BOX 115
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96257
Practice Address - Country:US
Practice Address - Phone:213-309-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical