Provider Demographics
NPI:1417957721
Name:KANG, CHUNGKIL LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNGKIL
Middle Name:LEWIS
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 1:934 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4063
Mailing Address - Country:US
Mailing Address - Phone:419-289-3663
Mailing Address - Fax:419-289-2199
Practice Address - Street 1:934 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4063
Practice Address - Country:US
Practice Address - Phone:419-289-3663
Practice Address - Fax:419-289-2199
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-039764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336176Medicaid
OH1417957721OtherCGS ADMINISTRATORS, LLC
OH34-1222038OtherFLORA
OH106485OtherUNITEDHEALTHCARE COMMU ITY PLAN
OH34-1222038OtherUNITED HEALTHCARE
OH341222038-002OtherMEDICAL MUTUAL OF OHIO
OH000000106485OtherUNISON
OH34-1222038OtherAETNA
OH34-1222038OtherPARAMOUNT
OH341222038027OtherCARESOURCE
OH341222038OtherHUMANA
OH34-1222038OtherEMERALD
OH735309OtherBUCKEYE
OH000000128733OtherANTHEM
OHP00137396OtherRAILROAD MEDICARE
OHP00137396OtherRAILROAD MEDICARE
OH0434702Medicare PIN