Provider Demographics
NPI:1003822057
Name:KANG, TERESA KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:KIM
Last Name:KANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12233 116TH AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6911
Mailing Address - Country:US
Mailing Address - Phone:425-821-8411
Mailing Address - Fax:
Practice Address - Street 1:12332 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6926
Practice Address - Country:US
Practice Address - Phone:425-821-8411
Practice Address - Fax:425-821-5188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist