Provider Demographics
NPI:1245564517
Name:MICHAEL C. KANG, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL C. KANG, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PLLC
Authorized Official - Phone:425-747-8888
Mailing Address - Street 1:4100 FACTORIA BLVD SE STE D
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1262
Mailing Address - Country:US
Mailing Address - Phone:425-747-8888
Mailing Address - Fax:425-564-8562
Practice Address - Street 1:4100 FACTORIA BLVD SE STE D
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1262
Practice Address - Country:US
Practice Address - Phone:425-747-8888
Practice Address - Fax:425-564-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA94161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty