Provider Demographics
NPI:1366506206
Name:KANG, DAVID MYUNG-SUP (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MYUNG-SUP
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 1:950 STOCKTON ST
Mailing Address - Street 2:SIUTE 202
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1633
Mailing Address - Country:US
Mailing Address - Phone:415-827-3323
Mailing Address - Fax:415-986-9500
Practice Address - Street 1:950 STOCKTON ST
Practice Address - Street 2:SIUTE 202
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1633
Practice Address - Country:US
Practice Address - Phone:415-827-3323
Practice Address - Fax:415-986-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73548208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G735480Medicaid
CA00G735480Medicare ID - Type Unspecified
CA00G735480Medicaid