Provider Demographics
NPI:1013376110
Name:MICHAEL KANG, DMD, MMSC, PLLC
Entity Type:Organization
Organization Name:MICHAEL KANG, DMD, MMSC, PLLC
Other - Org Name:ENDODONTICS SEATTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MMSC
Authorized Official - Phone:206-624-8313
Mailing Address - Street 1:509 OLIVE WAY STE 1633
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1770
Mailing Address - Country:US
Mailing Address - Phone:206-624-8313
Mailing Address - Fax:206-624-8922
Practice Address - Street 1:509 OLIVE WAY STE 1633
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1770
Practice Address - Country:US
Practice Address - Phone:206-624-8313
Practice Address - Fax:206-624-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60567455261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental