Johanah Y Kang, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY60805166 Issued in WA

Practice address

2013 South 19TH Street
Tacoma, WA 98405

Phone

(253) 383-3355

Fax

(253) 383-3627

NPI assigned

Feb 8, 2018

Last updated

Feb 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2025 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Behavioral Medicine

  • Specialist
  • Tacoma, WA
  • NPI 1578964367
  NPD (past)
• Connect Neuropsychology, PLLC

  • Clinical Neuropsychologist
  • Gig Harbor, WA
  • NPI 1437973070
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518048000000",
    "number": "1588163208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2013 SOUTH 19TH STREET",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98405",
            "telephone_number": "253-383-3355",
            "fax_number": "253-383-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 SOUTH 19TH STREET",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98405",
            "telephone_number": "253-383-3355",
            "fax_number": "253-383-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "JOHANAH",
        "middle_name": "Y",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WA",
            "license": "PY60805166",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60805166",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Gene Kang, MD
• Eunyoung Kang, M.D.
• Heejin Kang, RN
• Hyerin Kang
• Jiajing Kang
• Sarah Jeanhee Kang
• Shinje Kang, PHYSICIAN ASSISTANT
• Steven S Kang, MD
• Young Ri Kang, FNP
• John Kimemia Kangara, LPN

• Clinical Neuropsychologist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Clinical Neuropsychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.