Provider Demographics
NPI:1437269552
Name:KANG, JAMIE SEON (DMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SEON
Last Name:KANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 SOUTH CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-821-1130
Mailing Address - Fax:610-821-7705
Practice Address - Street 1:1245 SOUTH CEDAR CREST BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-821-1130
Practice Address - Fax:610-821-7705
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030892L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist