Provider Demographics
NPI:1851275515
Name:REYELTS, KANG AE
Entity type:Individual
Prefix:
First Name:KANG AE
Middle Name:
Last Name:REYELTS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12012 N 158TH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-7422
Mailing Address - Country:US
Mailing Address - Phone:402-981-9439
Mailing Address - Fax:
Practice Address - Street 1:12012 N 158TH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-7422
Practice Address - Country:US
Practice Address - Phone:402-981-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant