Provider Demographics
NPI:1609439033
Name:BENJAMIN KANG, DDS, PHD, PLLC
Entity Type:Organization
Organization Name:BENJAMIN KANG, DDS, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-900-9182
Mailing Address - Street 1:5091 BUCKLEY DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6815
Mailing Address - Country:US
Mailing Address - Phone:562-900-9182
Mailing Address - Fax:
Practice Address - Street 1:4500 SAND POINT WAY NE STE 212
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3925
Practice Address - Country:US
Practice Address - Phone:206-524-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental