Provider Demographics
NPI:1033524509
Name:KANG, AIMEE (DDS)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
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 1:618 S LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4409
Mailing Address - Country:US
Mailing Address - Phone:214-862-4898
Mailing Address - Fax:
Practice Address - Street 1:16141 BOLSA CHICA ST STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2458
Practice Address - Country:US
Practice Address - Phone:714-846-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN263390200000X
CA24559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program