Provider Demographics
NPI:1053574251
Name:KANG, WAN SIHK (LAC)
Entity type:Individual
Prefix:
First Name:WAN
Middle Name:SIHK
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:3200 INLAND EMPIRE BLVD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5513
Mailing Address - Country:US
Mailing Address - Phone:909-373-2412
Mailing Address - Fax:909-466-7784
Practice Address - Street 1:44105 JACKSON ST
Practice Address - Street 2:UNIT B
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3275
Practice Address - Country:US
Practice Address - Phone:760-863-5432
Practice Address - Fax:760-863-5492
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC7135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist