Provider Demographics
NPI:1164599213
Name:KANG, BYUNG K (MD)
Entity Type:Individual
Prefix:MR
First Name:BYUNG
Middle Name:K
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 1:122 LONG HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-256-6162
Mailing Address - Fax:973-256-2731
Practice Address - Street 1:122 LONG HILL ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:973-256-6162
Practice Address - Fax:973-256-2731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA025122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2515806Medicaid
C55921Medicare UPIN
NJ2515806Medicaid