Provider Demographics
NPI:1023356169
Name:LANG, KC BRYN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KC BRYN
Middle Name:
Last Name:LANG
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:154-561-8252
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1200 W TABOR RD FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3019
Practice Address - Country:US
Practice Address - Phone:215-456-3815
Practice Address - Fax:215-456-6803
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2024-12-19
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Provider Licenses
StateLicense IDTaxonomies
PAMA056031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant