Provider Demographics
NPI:1639191687
Name:KANG, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31720 DAGSBORO RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2225
Mailing Address - Country:US
Mailing Address - Phone:410-749-4154
Mailing Address - Fax:410-860-9583
Practice Address - Street 1:1675 WOODBROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-749-4154
Practice Address - Fax:410-860-9583
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057353207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7910476OtherAETNA
VA1639191687Medicaid
DE1639191687Medicaid
002786938OtherBCBS DE
MD699809760Medicaid
MD200042200OtherRAILROAD MEDICARE
221921800OtherUS DEPARTMENT OF LABOR
4236567OtherCIGNA
MD200042200OtherRAILROAD MEDICARE
DE1639191687Medicaid
DE378016ZD7RMedicare PIN
MD699809700Medicaid
0005W409OtherBCBS PROD FEP BLUE CHOICE
G90507Medicare UPIN