Provider Demographics
NPI:1437256435
Name:KANG, JEAN YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:YOUNG
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 1:1611 KRESKY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8982
Mailing Address - Country:US
Mailing Address - Phone:360-736-5437
Mailing Address - Fax:
Practice Address - Street 1:895 E FREMONT AVE STE 203
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2973
Practice Address - Country:US
Practice Address - Phone:408-774-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502841223G0001X
WADE61232825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice