Provider Demographics
NPI:1083799316
Name:KANG, CHRISTOPHER (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 W. AVENUE M14
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-266-8840
Mailing Address - Fax:661-266-8824
Practice Address - Street 1:1137 W. AVENUE M14
Practice Address - Street 2:SUITE 101
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-266-8840
Practice Address - Fax:661-266-8824
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114821223S0112X
CA0579701223S0112X
CA57970204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery