Provider Information for 1528540721
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YOONHEE NIKKI KANG
Sex: Female
NPI: 1528540721
Last Updated: 2019-03-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1528540721 | ||||||||
| Enumeration Date | 2018-09-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 109 N FAIRLAND ST PRYOR, OK 74361-4203 United States Phone: 918-825-1405 | Fax:918-825-1406 | ||||||||
| Primary Practice Address | 109 N FAIRLAND ST PRYOR, OK 74361 United States Phone: 918-825-1405 | Fax:918-825-1406 | ||||||||
| Secondary Practice Address(es) | 602 SW 38TH ST | ||||||||
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