Provider Demographics
NPI:1437378478
Name:BOBBY C. KANG, P.C.
Entity Type:Organization
Organization Name:BOBBY C. KANG, P.C.
Other - Org Name:ENID REGIONAL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:CHU
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-233-7600
Mailing Address - Street 1:2426 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5221
Mailing Address - Country:US
Mailing Address - Phone:580-233-7600
Mailing Address - Fax:580-233-7661
Practice Address - Street 1:2426 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5221
Practice Address - Country:US
Practice Address - Phone:580-233-7600
Practice Address - Fax:580-233-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100215980CMedicaid
D24734Medicare UPIN
OK100215980CMedicaid