Provider Demographics
NPI:1659318285
Name:KANG, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
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 1:1457 RARITAN RD
Mailing Address - Street 2:203
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1252
Mailing Address - Country:US
Mailing Address - Phone:908-709-4114
Mailing Address - Fax:908-709-8011
Practice Address - Street 1:1457 RARITAN RD
Practice Address - Street 2:203
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1252
Practice Address - Country:US
Practice Address - Phone:908-709-4114
Practice Address - Fax:908-709-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ57989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6368106Medicaid
F40188Medicare UPIN
141602Medicare ID - Type Unspecified