Provider Demographics
NPI:1568401560
Name:KANG, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8117
Mailing Address - Country:US
Mailing Address - Phone:617-735-4290
Mailing Address - Fax:617-735-4207
Practice Address - Street 1:3 BLACKFAN CIR
Practice Address - Street 2:CLS 910
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5400
Practice Address - Country:US
Practice Address - Phone:617-735-4290
Practice Address - Fax:617-735-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80849207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease