Active NPI
Kangho Ang
- Student in an Organized Health Care Education/Training Program
- Stockton, CA
National Provider Identifier
1013048644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 7707 Austin Rd
Stockton, CA 95215-8312 - Phone
- (209) 467-8546
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 29668 | CA | |
| Social Worker | 104100000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
7707 Austin Rd
Stockton, CA 95215-8312
Mailing address
2327 Mumbert Dr
Manteca, CA 95337-7807
Phone (408) 505-7733
Other practice location 1
7707 Austin Rd
Stockton, CA 95215-8312
Phone (209) 467-8546
Other practice location 2
210 N 4th St Ste 100
San Jose, CA 95112-5573
Phone (408) 295-5288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29668 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697500800000",
"number": "1013048644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2327 MUMBERT DR",
"city": "MANTECA",
"state": "CA",
"postal_code": "953377807",
"telephone_number": "408-505-7733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7707 AUSTIN RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952158312",
"telephone_number": "209-467-8546"
}
],
"practiceLocations": [
{
"address_1": "7707 Austin Rd",
"address_purpose": "LOCATION",
"city": "Stockton",
"state": "CA",
"postal_code": "952158312",
"country_code": "US",
"telephone_number": "209-467-8546",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "210 N 4th St Ste 100",
"address_purpose": "LOCATION",
"city": "San Jose",
"state": "CA",
"postal_code": "951125573",
"country_code": "US",
"telephone_number": "408-295-5288",
"fax_number": "408-292-1029",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANG",
"first_name": "KANGHO",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2023-10-17",
"certification_date": "2023-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29668",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.