Provider Demographics
NPI:1609512334
Name:KANG, JOO HEE (DMD)
Entity Type:Individual
Prefix:
First Name:JOO HEE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W 50TH ST APT 19A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6674
Mailing Address - Country:US
Mailing Address - Phone:404-397-9683
Mailing Address - Fax:
Practice Address - Street 1:350 W 50TH ST APT 19A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6674
Practice Address - Country:US
Practice Address - Phone:404-397-9683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02957000122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist