Ku in Kang
Individual provider Active NPI Physician Assistant · Hagatna, GU
NPI 1902267461 · NPPES record last updated Mar 11, 2016
Key facts
- NPI
- 1902267461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA-110 (GU)
- Practice address
- 302 South Route 4
207
Hagatna, GU 96932 - Phone
- (671) 477-2873
- NPI assigned
- Mar 11, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GU
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210917002612 | GU | Order and Referring Only - Physician Assistant | 9537431689 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Expresscare Health and Skin Center | Past | Accepting new patients | |
| Expresscare Health and Skin Center Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-110 | GU | Yes |
Addresses
Primary practice location
302 South Route 4
207
Hagatna, GU 96932
Mailing address
302 South Route 4
207
Hagatna, GU 96932
Phone (671) 477-2873
Other providers in Hagatna, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.