1508559139 NPI number — KATRYNA ELENA GINA KANG ABOC, NCLEC

Table of content: KATRYNA ELENA GINA KANG ABOC, NCLEC (NPI 1508559139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508559139 NPI number — KATRYNA ELENA GINA KANG ABOC, NCLEC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANG
Provider First Name:
KATRYNA
Provider Middle Name:
ELENA GINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ABOC, NCLEC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508559139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95-550 LANIKUHANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILILANI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96789-1783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-623-9200
Provider Business Mailing Address Fax Number:
808-623-9677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95-550 LANIKUHANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILILANI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96789-1783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-623-9200
Provider Business Practice Location Address Fax Number:
808-623-9677
Provider Enumeration Date:
05/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  455 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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