Provider Demographics
NPI:1306846035
Name:KANG, AJAIPAL
Entity Type:Individual
Prefix:
First Name:AJAIPAL
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEACH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-877-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4253932086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00339476OtherRR MEDICARE
PA1545628OtherGATEWAY
PA1736065OtherBLUE SHIELD
PA1012455660001Medicaid
PA410606OtherUPMC
NY00027351501OtherUNIVERA
NY02647189OtherNY MEDICAL ASSISTANCE
WV1068819OtherWEST VIRGINIA WORK COMP
OH2563560OtherOH MEDICAL ASSISTANCE
PA166222OtherUNISON
PA3960984OtherAETNA
WV1068819OtherWEST VIRGINIA WORK COMP
H01202Medicare UPIN