Provider Demographics
NPI:1447226808
Name:KANG, CHRISTOPHER C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10710 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE # 150
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1827
Mailing Address - Country:US
Mailing Address - Phone:770-497-4188
Mailing Address - Fax:770-497-4189
Practice Address - Street 1:10710 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1827
Practice Address - Country:US
Practice Address - Phone:770-497-4188
Practice Address - Fax:770-497-4189
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5H54207R00000X, 208M00000X
IL036074653207R00000X, 208M00000X
GA39141207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00346630OtherRAILROAD MEDICARE
IL036074653Medicaid
ILK13775Medicare PIN
MOE32191Medicare UPIN
IL036074653Medicaid