Provider Demographics
NPI:1164484630
Name:KANG, OK KYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:OK
Middle Name:KYUN
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9463 HOLLY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8351
Mailing Address - Country:US
Mailing Address - Phone:810-579-2600
Mailing Address - Fax:810-579-2601
Practice Address - Street 1:9463 HOLLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8351
Practice Address - Country:US
Practice Address - Phone:810-579-2600
Practice Address - Fax:810-579-2601
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIOK034453208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA74239Medicare UPIN
MI0258245Medicare ID - Type UnspecifiedOK K. KANG, M.D.
MIA74239Medicare UPIN