Provider Demographics
NPI:1518293695
Name:KANG, JOON-YI (MD)
Entity Type:Individual
Prefix:
First Name:JOON-YI
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9910 FRANKLIN SQUARE DR
Mailing Address - Street 2:2110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MEYER 2-147
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-6772
Practice Address - Fax:410-955-0751
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD801842084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100676200Medicaid
MD441626YVAMedicare PIN