Provider Demographics
NPI:1316226335
Name:KANG, PEGGY Y (DDS)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:Y
Last Name:KANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2537
Mailing Address - Country:US
Mailing Address - Phone:626-643-5353
Mailing Address - Fax:626-614-0191
Practice Address - Street 1:3149 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2537
Practice Address - Country:US
Practice Address - Phone:626-643-5353
Practice Address - Fax:626-614-0191
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice