Provider Demographics
NPI:1467833889
Name:KANG, JINA (DDS)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:
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 1:1568 INDIAN TRAIL LILBURN RD # 202
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2647
Mailing Address - Country:US
Mailing Address - Phone:770-609-6106
Mailing Address - Fax:
Practice Address - Street 1:1568 INDIAN TRAIL LILBURN RD # 202
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2647
Practice Address - Country:US
Practice Address - Phone:770-609-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1224971223G0001X
WADE60658558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice