Provider Demographics
NPI:1538378229
Name:KANG, ROGER YOUN JIN
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:YOUN JIN
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YOUN
Other - Middle Name:JIN
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPEDCOF
Mailing Address - Street 1:515 W FIREWEED LN
Mailing Address - Street 2:ANCHORAGE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1927
Mailing Address - Country:US
Mailing Address - Phone:907-865-7999
Mailing Address - Fax:907-865-7998
Practice Address - Street 1:515 W FIREWEED LN
Practice Address - Street 2:ANCHORAGE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1927
Practice Address - Country:US
Practice Address - Phone:907-865-7999
Practice Address - Fax:907-865-7998
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter