Provider Demographics
NPI:1073697892
Name:KANG, THOMAS C (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 UNION AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3501
Mailing Address - Country:US
Mailing Address - Phone:425-271-4120
Mailing Address - Fax:253-874-0968
Practice Address - Street 1:2505 S 320TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5400
Practice Address - Country:US
Practice Address - Phone:206-400-0800
Practice Address - Fax:523-874-9068
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00010542WOtherWA. STATE I.D.
WABK9779274OtherDEA #