Provider Demographics
NPI:1467973636
Name:KANG, MICHAEL MO (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MO
Last Name:KANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 FRANKLIN ST UNIT 316
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6299
Mailing Address - Country:US
Mailing Address - Phone:631-371-9279
Mailing Address - Fax:
Practice Address - Street 1:176 AUBURN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1635
Practice Address - Country:US
Practice Address - Phone:508-832-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581071223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics