Provider Demographics
NPI:1528369717
Name:KANG, SHIRLEY Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:Y
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 1:1125 KOHLENBERGER DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 E LINCOLN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2261
Practice Address - Country:US
Practice Address - Phone:714-774-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice