Individual
IKSOO KANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 E VALENCIA MESA DR, EM DEPT, FULLERTON, CA 92835-3809
(714) 992-3965
Mailing address
4401 W MEMORIAL RD, SUITE 121, OKLAHOMA CITY, OK 73134-1785
(405) 751-4664
(405) 749-4561
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A70734
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A707340
BLUE SHIELD
CA
05
—
00A707340
—
CA
01
—
A70734
ANTHEM BLUE CROSS
CA
Enumeration date
06/14/2006
Last updated
03/11/2009
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