Provider Demographics
NPI:1710396593
Name:KANG, SOPHIA (DDS)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4019
Mailing Address - Country:US
Mailing Address - Phone:931-484-3007
Mailing Address - Fax:931-484-8007
Practice Address - Street 1:510 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4019
Practice Address - Country:US
Practice Address - Phone:931-484-3007
Practice Address - Fax:931-484-8007
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist