Provider Demographics
NPI:1093136087
Name:DENO D KANG M D INC
Entity Type:Organization
Organization Name:DENO D KANG M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-319-8976
Mailing Address - Street 1:18102 PIONEER BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3953
Mailing Address - Country:US
Mailing Address - Phone:562-402-9801
Mailing Address - Fax:562-402-9802
Practice Address - Street 1:18102 PIONEER BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3953
Practice Address - Country:US
Practice Address - Phone:562-402-9801
Practice Address - Fax:562-402-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60288207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602880Medicaid
CA00A602880Medicaid