Provider Demographics
NPI:1730356973
Name:MARK M. KANG, M.D.
Entity type:Organization
Organization Name:MARK M. KANG, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-527-8027
Mailing Address - Street 1:1687 ERRINGER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6509
Mailing Address - Country:US
Mailing Address - Phone:805-527-8027
Mailing Address - Fax:805-522-7148
Practice Address - Street 1:1687 ERRINGER RD STE 103
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6509
Practice Address - Country:US
Practice Address - Phone:805-527-8027
Practice Address - Fax:805-522-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321050Medicaid
CAB50183Medicare UPIN
CAA32105AMedicare PIN