Provider Demographics
NPI:1043768864
Name:AHMED AND KANG PS
Entity Type:Organization
Organization Name:AHMED AND KANG PS
Other - Org Name:SUNRISE DENTAL OF MOUNT VERNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-848-6777
Mailing Address - Street 1:2120 FREEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5478
Mailing Address - Country:US
Mailing Address - Phone:360-848-6777
Mailing Address - Fax:
Practice Address - Street 1:2120 FREEWAY DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5478
Practice Address - Country:US
Practice Address - Phone:360-848-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60228356122300000X
WADE60104986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty