Provider Demographics
NPI:1396033932
Name:YOON H. KANG, DMD, PHD, LLC
Entity Type:Organization
Organization Name:YOON H. KANG, DMD, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON
Authorized Official - Middle Name:H
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PHD
Authorized Official - Phone:617-244-8087
Mailing Address - Street 1:25 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1721
Mailing Address - Country:US
Mailing Address - Phone:617-244-8087
Mailing Address - Fax:508-319-3090
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-244-8087
Practice Address - Fax:508-319-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22133261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental