Provider Demographics
NPI:1447644919
Name:KANG, SHARON MEEJUNG (LAC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MEEJUNG
Last Name:KANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W COLLEGE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3059
Mailing Address - Country:US
Mailing Address - Phone:213-617-8163
Mailing Address - Fax:
Practice Address - Street 1:625 W COLLEGE ST STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3059
Practice Address - Country:US
Practice Address - Phone:213-617-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist