Provider Demographics
NPI:1073532966
Name:KANG, HONG SIK (MD)
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:SIK
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 OAKLAND AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2937
Mailing Address - Country:US
Mailing Address - Phone:740-354-4660
Mailing Address - Fax:740-354-2465
Practice Address - Street 1:1825 OAKLAND AVE STE 3B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2937
Practice Address - Country:US
Practice Address - Phone:740-354-4660
Practice Address - Fax:740-354-2465
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-30222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420851Medicaid
OH0420851Medicaid
OH0487163Medicare ID - Type Unspecified